Hello everyone, I'm Dr. Lee.
22-year-old female college student, just graduated, surnamed District.
These days, the body is particularly uncomfortable, the whole body is weak, there is no energy at work, and it is not good to eat and sleep. Later, when I looked in the mirror, I found that my skin had turned yellow, and at first I thought that I had not rested well, but later I found that the eyeballs (the patient's original words, in fact, should be the sclera of the eye, the white part of the eye) also turned yellow...
This is definitely problematic. Miss District began to be vigilant.
So I went to the emergency room.
The emergency department doctor who received the treatment was the old horse doctor we were familiar with, an old man who had been in the emergency department for more than ten years. As soon as Lao Ma saw this girl, he knew that things were not good. Because her whole body was yellow, the skin from head to toe was yellow, yellow enough to make people panic.
Why did you come to the hospital after all this? The old horse blamed the patient a little. But when you say it, you regret it, and saying it now will not help, it will only increase the psychological burden of the patient.
In fact, Miss Ou found that her skin was not right, but because the yellowing of the skin was gradually aggravated, coupled with some colds these days, the body was uncomfortable, the spirit was not good, and she did not care too much.
The old horse was unusually vigilant, because the vast majority of patients with yellowing skin encountered in the emergency department were liver problems. The red blood cells in our body are lifespan, after the death of red blood cells, the proteins inside will be catabolized into bilirubin, which will be transported to the liver to be processed, and if the liver is damaged, the processing capacity will decline, it will lead to excessive accumulation of bilirubin in the blood, excess bilirubin will be deposited in our skin, sclera and other places, which will cause the skin and sclera to turn yellow (not red), we call it jaundice.
The young woman in front of me is obviously jaundiced.
The old horse carefully inquired about all her situation, first wondering if she would have acute viral hepatitis, such as acute hepatitis B, which is very common after all. But Miss Ou said that she had a physical examination, there was no hepatitis B, and she clearly remembered that she had been vaccinated against hepatitis B, and she also re-injected the vaccine last year.
In addition to acute hepatitis B, other hepatitis can also cause jaundice, the old horse calculated in his heart. Patients may not know what their illness is and may have to do some tests, including abdominal ultrasound, and blood tests.
Later, Miss Ou said that she had some colds these days and did not know whether her yellowing body had anything to do with colds.
The old horse shook his head and said that a cold would not cause jaundice. Colds may have myocarditis, viral myocarditis, but have never seen the feeling of causing severe damage to the liver and then jaundice ... As soon as the words fell silent, the old horse involuntarily shouted out, the sound was not loud, but Miss Ou was sitting opposite, and it was obvious that she could hear it.
Lao Ma's heart suddenly mentioned the throat eye, stared at Miss Ou, and asked her, what medicine do you take for a cold.
Miss Ou's spirit is not very good, but what medicine she took is still clearly remembered, said that she first ate bi Li Tong, and then ate some cold spirit granules, and also ate almost a box of cefladin, before and after eating for 5 days. Miss Ou took out her mobile phone as she spoke, found a photo of the medicine she had taken, and handed it to the old horse to see.
At this moment, a very terrible possibility came to the mind of the old horse. That is liver damage caused by drug overdose. Why do you say this, because the few medicines that Miss Ou took were really problematic.
It is not that there is a problem with these drugs, but that if Miss District bought these drugs herself and ate them together, it is entirely possible to eat too much and eat heavily, and it is entirely possible that the drug will be overdose and lead to liver damage.
Especially this must be rational, cold spirit particles.
You may not know what their main ingredients are. In fact, the main ingredient of these two drugs is acetaminophen, a very commonly used antipyretic and analgesic.
How many of these two pills did you take in total. The old horse pointed to the bi li tong and cold spirit particles in the picture and asked the patient.
I don't remember much, but I bought two boxes of each and almost finished eating them. Miss Ou seemed to be aware of the problem, and was a little weak in the face of lao Ma's questioning.
Are you eating together? The old horse asked again.
Yes, I just ate at the beginning of the must be rational, it seems that the effect is not very good, there is a fever, people are tired, and then bought cold spirit granules and those two pills, at first it seems to be better, and then it is not ok...
The old horse rolled his eyes in his heart, and really wanted to yell at her, saying that you have been reading books for so many years in vain, you will not read the instructions when taking medicine, and you should not read the instructions when taking medicine. Combination medication may be overdose, and overdose may lead to human life. Bi Li Tong (acetaminophen tablets) has 0.5 g of acetaminophen, and can not exceed 4 tablets a day. The main ingredient of cold spirit is also paracetamol, which has 0.2g of paracetamol per bag. If it is used jointly, it will be excessive if it is not careful. The old horse endured, did not count the patients, first, he felt that the patient was a delicate girl who was strange and pitiful, and second, saying these words at this moment really did not help.
Find a way to solve the problem.
The first thing to do is to determine whether the liver damage caused by the drug is the end.
First draw blood to test liver and kidney function, electrolytes, blood routine, coagulation indicators, etc., and then let her do an abdominal ultrasound, and also take a chest X-ray to see if pneumonia is possible, after all, some patients with colds may have pneumonia.
The results came out, and the old horse was even more worried.
Liver function in patients suggests a significant increase in transaminases of 900 U/L (normal 0 to 40) and a marked increase in bilirubin. There is no doubt that these results are very abnormal, and the patient's liver function is impaired.
Abdominal ultrasound B did not see obvious abnormalities, no gallbladder stones, cholecystitis, liver is not large, no liver cancer, cirrhosis and other manifestations.
In addition, kidney function, blood routine, coagulation indicators, etc. are quite normal.
Considering that the patient may develop liver failure, Lao Ma recommended that she be hospitalized. Miss Ou did not agree at first, but later Lao Ma intimidated her, saying that she would sign if she did not agree, and that anything after being discharged from the hospital had nothing to do with me. Miss District reluctantly agreed to be hospitalized.
Hospitalization is really inconvenient, and no one likes to be hospitalized.
Income in Gastroenterology.
After the gastroenterologist saw Miss Ou's medical records, he agreed to the diagnosis of liver damage, but the cause was not clear, the cause of liver damage was too much, common viral hepatitis, other viral infections, autoimmune liver disease, etc., can not be considered at the beginning is caused by drug overdose, and the gastroenterologist carefully analyzed the dose of the several drugs that Miss Ou had eaten, although the dose of acetaminophen was a little larger, but it was only beyond the limit, not necessarily the liver damage caused by it.
Other tests were later refined and found that there was no other reason to explain the liver damage than the drug. Ct of the abdomen was also done, but no obvious abnormalities were found. Liver size and morphology are also basically normal.
After admission, symptomatic supportive treatment such as liver protection and yellowing and improvement of circulation is given. I am ready to be discharged from the hospital in a few days.
However, on the third day of admission, the situation took a sharp turn for the worse.
Re-examination of liver function shows that the transaminases have begun to decline, but bilirubin continues to rise. This is an unusually sinister signal. Do not think that the decline in transaminases is a good thing, because at the same time bilirubin rises, clinically this situation is called bile enzyme isolation, which means that bilirubin rises, and transaminases decrease, the two indicators go backwards, which represents that the liver damage is further aggravated, it can be simply understood that the transaminases are consumed, so it begins to decrease, and at this time bilirubin has just begun to float...
Along with the isolation of bile enzymes, the patient's coagulation index is abnormal, and the thrombin and other indicators are elevated, which means that the patient's coagulation system is also a problem. Most of the coagulation factors in the human body are synthesized by the liver, if the liver function is impaired, the synthesis of coagulation factors is naturally less, then the coagulation function will become worse.
All indications are that the patient's liver is almost unable to bear it.
The gastroenterologist also began to get nervous, discussed several times, and gave symptomatic supportive treatment. But the effect is minimal. In the afternoon, the patient's consciousness was not good, the spirit was even worse, and the answer to the question was not what was asked, and he was drowsy.
It sucks.
The patient's parents also came.
In a patient with severe liver damage, if there is a change in the state of consciousness, the doctor must first consider whether it will be hepatic encephalopathy. Simply put, after the liver is severely damaged, the brain function will also be impaired. A check of the patient's blood ammonia is also a high mess. When the liver is seriously damaged, the body's metabolism is obviously disordered, the ammonia in the blood will also be significantly increased, and the blood ammonia may lead to brain disorders, which is hepatic encephalopathy.
This time the doctor was really panicked.
Originally a big living person who could walk and move, it was only a relatively high transaminases index, and the whole person was almost comatose after a few days of hospitalization, which was not justified. Medical peers certainly understand that this is indeed the case with explosive hepatitis or liver failure.
But family members are not medical peers.
Gastroenterologists are also worried about another problem, the patient's liver failure, coagulation indicators will become worse, is there a possibility of cerebral hemorrhage? Cerebral hemorrhage can also lead to a deterioration of consciousness, and even lead to coma. Originally, the limb muscle strength and muscle tone of patients with cerebral hemorrhage will be more or less changed, but the patient is now in a coma, the examination does not cooperate, and tries to rely on the examination to diagnose or exclude cerebral hemorrhage, which is too dramatic.
I had to review the CT of the skull and do the CT of the abdomen by the way.
The head CT was done and the patient did not have cerebral hemorrhage. The doctor breathed a sigh of relief. But this breath did not relax for long and was held again. Because the patient was directly unconscious that night.
Unconscious, it is not enough.
CT saw a marked reduction in the liver.
Looking at all the indicators, looking at the patient's medical history and clinical manifestations before and after, it is indeed a liver failure. And most likely, it is drug-induced liver damage and liver failure caused by excessive paracetamol!
This is the conclusion given by the gastroenterologist.
Send the ICU, this is the last resort.
The ICU has the best equipment and treatment measures in the hospital, the doctor tells the patient's family. Although the family was indignant, they signed and went to the ICU.
The patient's liver function is exhausted, the brain is also affected, the coagulation index is not good, the kidneys are dying, and the multi-organ failure. Immediately after transferring to the ICU, artificial liver plasma exchange + hemofiltration (similar to dialysis) and other treatments were given, and the endotracheal intubation was connected to a ventilator to ensure the patient's oxygen supply.
Later, the patient was in shock, his blood pressure was low, and he had to use a large dose of vasopressor drugs to maintain his blood pressure.
Since then, the patient's liver, heart, brain, kidneys, gastrointestinal tract, coagulation system, etc. have collapsed.
ICU doctors are rescuing around the clock. One by one, the critical illness notices were signed to the family members. More than a dozen informed consent forms were placed in front of the family, and the family members had no choice but to cry.
Human tragedy.
The age of the flower season, life and death are uncertain.
The family said that they would do their best no matter what, and ICU doctors have repeatedly said that they will try to treat them.
But reality is not a story.
After 48 hours of rescue, the patient finally had a heartbeat and respiratory arrest, and the rescue was ineffective and died.
This is a tragedy.
A tragedy that seems to be avoidable.
If the patient would have read the instructions and knew that similar drugs could not be used together, or that the dose should not exceed the instructions, then liver damage would not occur and there would be no subsequent list of things.
Wouldn't it be better if the doctor had held on to the drug-induced liver injury at the beginning and done all kinds of strong symptomatic supportive treatments at the beginning?
I don't know.
Acetaminophen is a very commonly used fever reducer, and everyone should not waste food because of choking. At present, there are not many most commonly used and safe antipyretic drugs, one is ibuprofen, and the other is acetaminophen, which can be used by children. But be sure to master the dosage. Especially acetaminophen, the instructions say that you can not exceed 4 tablets a day, you do not eat 5 tablets, who will protect you?
A small cold, take some medicine is not good, then observe it, or do not take medicine is also OK, there is no need to rush to the doctor and buy other drugs to eat together, this is really self-inflicted pain ah. If you have to use a combination of drugs, you should also look at the instructions to see if they are drugs of the same ingredient, and if so, be cautious, because it may cause excessive drug doses.
blessing.
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