After seeing the patient, Zheng Ren was startled.
The patient's system panel was redder than he thought. Everything he had considered before was wrong. The patient's diagnosis was a very common disease that rarely causes hypoglycemia.
"Boss Zheng, this is my client, named Du Liang." Lawyer Ge introduced.
"Well, let's come to the emergency room first." Zheng Ren took Du Liang to the emergency room and began to conduct routine consultations.
Du Liang looked to be in his 50s and was in a depressed state, but his speech and conversation were fine, which was considered normal.
His mood is normal, his memory and calculation skills are normal, his orientation is intact, and his insight is normal, all of which are fine.
"Have you been feeling uncomfortable lately?" Zheng Ren asked.
"Uncomfortable..." Du Liang hesitated for a moment, shook his head, but nodded again the next second, "Doctor, I often lose my mind. When I wake up, I find that what happened a while ago is blank and I can't remember it at all. Get up what happened.”
"And after I wake up, my back hurts, and sometimes my whole body hurts, especially my face."
Su Yun almost laughed.
Doesn't it hurt? I just slapped my mouth like that. It's a damn thing if it doesn't hurt.
"Do you feel any other discomfort? Do you have any weight..." Before Zheng Ren could finish asking, Du Liang's hands began to tremble, as if he was out of control, and he slapped his face.
Zheng Ren really wanted to cut his carotid sinus with a knife, but the case of the deceased just now made him hesitate.
"Are you sick? Mr. Zhou, check your fingertip blood sugar," Su Yundao said.
"What's your name?" Zheng Ren asked.
"I... I don't know... who am I?" Du Liang said vaguely, "I am Erlang God descended to earth, I remembered it!"
“…”
This could be regarded as slurred speech. Zheng Ren shook his head, watched the patient start to sweat, and immediately said: "After measuring the blood sugar, give 50ml of 50% glucose intravenously."
Zhou Litao's side started to get busy.
Blood sugar is very low, 1.6mmol/L. Within 3 minutes after the intravenous injection of high sugar, the patient slowly recovered.
Lawyer Ge had seen this situation before and was not very surprised.
Compared with the patient, he is more concerned about what Boss Zheng thinks. If you take someone to 912 yourself, even if you have sufficient evidence, you still have to bear a lot of responsibility.
"Let me think about it, Mr. Zhou, come with me." Zheng Ren said.
"good."
Several people walked out of the emergency room. Zhou Litao told a nurse to watch the patient and prevent anything from happening again.
"Boss, let's do a CT scan of the abdomen. I suspect there is something wrong with the pancreas." Su Yun said directly.
This was the organ that Zheng Ren had previously considered most likely to have problems, but the diagnosis of the system panel was another matter.
"Check the B-ultrasound and CT of the pancreas." Zheng Ren then said, "Check a lung CT."
Zhou Litao waited for Boss Zheng to continue giving the medical orders, but the orders were already over.
"Boss Zheng, is there nothing else?"
"Well, just check these three things." Zheng Ren said.
When admitted to the hospital for examination, plain X-rays or CT scans of the lungs are routine items. Others thought that Boss Zheng was just completing the relevant examinations and didn't pay much attention to it.
After placing orders and sending patients for examination, Zheng Ren sat in Zhou Litao's duty room and waited for Dr. Liang in the CT room to upload the film.
More than 20 minutes later, the CT scan of the pancreas was uploaded.
Overall, there were no special problems. The pancreatic membrane was intact and there was no growth. Hypoglycemia caused by tumors is more common in islet cell tumors, but the patient's pancreatic CT refuted this.
Soon, lung CT came back.
A 2×3.5cm space-occupying image of the right lower lung is so dazzling. The ground glass-like mass indicates the fact that it is a malignant tumor.
Zheng Ren sighed, the big pig's hoof was still as reliable as ever. Although it is rare, a lung CT scan can make a definite diagnosis immediately.
"Uh... is it hypoglycemia associated with tumors?!" Lin Yuan first said in surprise.
"Well, the diagnosis is lung cancer and tumor-associated hypoglycemia. Lin Yuan, call Lawyer Ge over." Zheng Ren said while carefully looking at the patient's lung CT.
"Okay." Lin Yuan ran out quickly. She was afraid that she would miss what Boss Zheng said while she was away.
Lawyer Ge trotted over.
"Lawyer Ge, I think the patient has lung cancer." Zheng Ren said directly without looking back.
"Lung cancer?!" Lawyer Ge was stunned.
"Yes." Zheng Ren said, "The hypoglycemia that caused the patient to talk nonsense and behave abnormally before is considered to be hypoglycemia associated with tumors. This is a symptom and not important."
"..." Lawyer Ge looked confused.
I just want to win a lawsuit, and hypoglycemia is enough for me to win. Why is there another case of hypoglycemia associated with tumors
Is the client really sick, and is it lung cancer? But how does lung cancer induce hypoglycemia
Lung cancer and hypoglycemia, these two words are not connected at all in Lawyer Ge's mind.
Not to mention Lawyer Ge, even Zhou Litao felt strange.
"Boss Zheng, please tell me in detail." Lawyer Ge said while rubbing his hands.
"Hypoglycemia associated with tumor usually occurs when there are clinical manifestations of the primary disease first or hypoglycemia occurs after the diagnosis of the primary disease; it is extremely rare that clinical hypoglycemia first occurs and then lung cancer is discovered."
"Uh... but hypoglycemia..." Lawyer Ge still didn't understand.
“Hypoglycemia is not an independent disease, but a syndrome of low blood glucose concentration caused by multiple reasons.
Causes of hypoglycemia include: nutritional hypoglycemia; hepatic hypoglycemia; renal hypoglycemia; hypoglycemia caused by autoimmune diseases; reactive hypoglycemia; hypoglycemia caused by endocrine diseases; non-islet cell tumors Cause hypoglycemia, etc. "Zheng Ren's series of thoughts and various professional terms confused Lawyer Ge.
"Among them, extrapancreatic tumors accompanied by hypoglycemia are less common. Other types of tumors related to hypoglycemia include mesenchymal tumors, accounting for 64%, of which 50% occur in the abdominal cavity, and hepatomas account for 21%. This patient's situation What’s even rarer is lung cancer.” Zheng Rendao.
"Why does this happen..." Lawyer Ge still didn't understand.
"Lin Yuan, tell Lawyer Ge why." Su Yun glanced at Lin Yuan and instructed.
"First of all, it is considered that the patient's symptoms are related to the secretion of insulin-like factor 2 by the tumor. IGF-2 binds to and activates the corresponding receptor, thereby increasing the uptake of glucose by peripheral tissues and reducing liver glycogen output, resulting in a decrease in blood glucose and hypoglycemia. Glycemic manifestations.”
Su Yun looked at Lin Yuan's way of saying one, two, three, and felt that he was a bit like his boss, he was too bookish.
"Secondly, the increased utilization of glucose by the tumor itself can also cause..." Lin Yuan did not pay attention to Su Yun's expression, but continued to explain the situation.