"It's definitely not the case. Do you know what chatting is?" Su Yun looked at Zheng Ren with disdain.
"Boss Zheng, what disease do you think it is?" Dr. Liang asked quickly.
"Just hearing your symptoms, I can't make any judgment yet." Zheng Ren said, "Bring the old lady to me later for a simple physical examination."
"Yes." Dr. Liang nodded.
Traditional Chinese medicine talks about looking, hearing, asking, and feeling, while Western medicine talks about sight, touch, percussion, and hearing. These are the most basic.
Su Yun looked through the test sheets again and saw that Dr. Liang had done a very comprehensive examination on his mother, and there was really nothing much to say.
Except for some minor problems with the ECG, everything else was normal, including the EEG, and the spikes were not obvious. It was impossible to diagnose any mental illness, let alone epileptic seizures.
Dr. Liang left the inspection report, said hello, and hurried to pick up the old man. After he left, Su Yun asked: "Boss, do you really have no guesses?"
"The only abnormality is the electrocardiogram." Zheng Ren took out the electrocardiogram, took another look at it, and said, "The PR and QT intervals are prolonged, the QRS wave is widened, the ST segment is depressed, and the T wave is widened. You will see these changes. What do you remember?"
"Not only these, but several waveforms can also show a decrease in the voltage of P wave and QRS wave complex. Looking at those waveforms, we must suspect hypomagnesemia. The standard is like a panda trying to eat bamboo." Su Yun said, Picking up the ion test report, "But look, the blood magnesium is normal."
"Pandas are carnivores..." Lin Yuan whispered.
"I don't know yet?" Su Yun glared at her and said, "How do you explain this?"
The next words were already spoken to Zheng Ren.
"Serum magnesium is normal, but it still cannot be determined that there is no magnesium ion deficiency. Because serum magnesium is greatly affected by changes in pH, protein and other factors, a simple ion test cannot explain anything." Zheng Rendao.
Su Yun shrugged, "Your statement is a bit cobbled together."
"Looking at the patients, some hypokalemia will also cause existing symptoms."
"You can't die if you don't talk nonsense." Su Yun said, "In diagnosing hypokalemia, identifying the U wave is the key. The general rule is that as the hypokalemia gradually worsens, the T wave gradually decreases, the U wave increases, and the U wave appears. There are more leads, the U wave is equal to or higher than the T wave in the same lead and appears hump-like, TU fusion cannot be distinguished and the ST segment moves downward."
Zheng Ren refused to argue with Su Yun because he had too little information at hand. The debate at hand is one of those situations where no one can convince anyone.
Soon, Dr. Liang brought his mother over. Zheng Ren saw the medium red system panel, and the diagnosis was clear—hypomagnesemia.
"Auntie, are you feeling uncomfortable?" Zheng Ren smiled and started asking about the medical history.
Although there was a diagnosis from Big Pig Hoof, Zheng Ren still started asking questions from the beginning, down to the smallest detail, so detailed that Lin Yuan felt it was a bit verbose.
The only positive medical history reported by the patient was paroxysmal foot spasms and nothing else.
After Zheng Ren asked, he said to Dr. Liang: "Liangzi, take your aunt to do a magnesium load test."
Dr. Liang was stunned for a moment and asked: "Boss Zheng, do you think it is hypomagnesemia?"
"Well, the spasm of the wrist and foot, the changes in the electrocardiogram, as well as the subtle tremors in your mother's eyes during the speech process, the reflexes were slightly hyperactive during the physical examination, and there was neuromuscular tremor. These are all considered to be hypomagnesemia. Although the serum ion test is normal, this disease cannot be ruled out."
"Okay." Dr. Liang took his old lady for examination.
"Boss, it looks quite similar now." After the physical examination, Su Yun did not express any objection. He pondered, "But how did it come about?"
Zheng Ren is also thinking about this issue.
Lin Yuan did not keep up with the thinking rhythm of Boss Zheng and Su Yun. In her opinion, it was miraculous enough to give a clear diagnosis of hypomagnesemia with only a slightly abnormal electrocardiogram, physical examination and medical history. .
As for how it came about... I'd better figure out how to diagnose it first.
"First, consider that there is too much loss in the digestive tract." Su Yun held the mobile phone in his hand and chatted with others while talking multitasking. "Because magnesium is absorbed in the small intestine and part of the colon, when severe diarrhea, Steatorrhea, malabsorption, intestinal fistulas, and post-resection of a large small intestine can all lead to hypomagnesemia."
"Well, I just asked, and I haven't had any surgery. Normal people should not have magnesium ion absorption problems. This can be ruled out." Zheng Ren sat on the chair, squinting his eyes, and also thinking about the condition of Dr. Liang's mother.
"Second, the kidneys lose too much. Chronic pyelonephritis, renal tubular acidosis, acute renal failure in the polyuria stage, or long-term use of loop diuretics, thiazides, and osmotic diuretics can cause renal magnesium loss and cause hypotension. Magnesemia.”
"I just asked, and it's not the case." Zheng Ren said, "I don't think it's a kidney problem."
"Loss has basically been taken into consideration, and then there is the possibility of insufficient replenishment and insufficient intake." Su Yundao said, "I think this is the most important point."
"But I asked just now, and Dr. Liang didn't find any problems with the family's diet. A while ago, I read a report saying that vegans are prone to hypomagnesemia. Old ladies who eat meat should not be affected. "
"Where's the drinking water?"
"Generally there will be no problem." Zheng Ren shook his head, "Trace elements are minerals that account for 0.01% of the body weight of the human body in the region. They mainly include 9 types: iron, zinc, copper, manganese, selenium, iodine, fluorine, cobalt and magnesium. And These elements cannot be synthesized by the human body and must be obtained from food.”
"The human body can only absorb trace elements in the organic state and can hardly absorb trace elements in the inorganic state. Most of the trace elements in the water are in the inorganic state and the content is very small."
"It has nothing to do with drinking water. People generally obtain trace elements from plants and animals."
"Boss, have you read a book? "Healthy Water" written by Dr. Martin Fox from the United States." Su Yun took the topic away again.
Zheng Ren shook his head.
"The book says that the standard for healthy water is to have a certain amount of hardness, ideally around 170mg/L, and a certain amount of total dissolved solids..."
"If you don't talk about this, how did you get hypomagnesemia? This disease is not common." Zheng Ren brought the topic back and continued to ask.
"There must be a medical history that I didn't ask clearly. Boss, your clinical skills are very poor. Xiao Linzi, I sent you to ask, and you must ask clearly." Su Yun said with a smile.
Lin Yuan was very interested and did not move or say much.
The medical history that Boss Zheng just asked about is already complete, and I don't know what to add.
And ask about the medical history again? The last time the patient had a patent foramen ovale accompanied by migraine was still vivid in his mind, and Lin Yuan was not willing to experience it again.