Today, the neurology department conducts a special ward round. Director Zhang is not only highly skilled, but also known for his rigorous teaching attitude and profound professional knowledge, and each ward round is a valuable opportunity for young doctors to learn and improve.
The protagonist of the case was a 65-year-old patient with cerebral hemorrhage, Uncle Lee, who was admitted to the hospital with a sudden severe headache and vomiting, and CT showed intracranial hemorrhage accompanied by significant cerebral edema. Uncle Lee's illness touched everyone's hearts, especially his attending doctor, Kobayashi, a diligent but inexperienced young doctor.
As Director Zhang's footsteps got closer and closer, the atmosphere in the ward became more solemn. Dr. Kobayashi nervously sorted out the medical records in his hand and prepared to report to the director.
"Director Zhang, this is Uncle Li's case." Kobayashi handed over the medical records and began to report, "The patient was admitted to the hospital with cerebral hemorrhage two days ago, and the main problem is increased intracranial pressure, and we have given mannitol for dehydration treatment, but the effect is limited, and the patient's kidney function has begun to decline." ”
Director Zhang nodded slightly, his eyes swept sharply over every item of data on the medical record, and then turned to Uncle Li and asked gently, "Uncle Li, how are you feeling now?" Is the headache a little better? ”
Uncle Li barely squeezed out a smile: "Director Zhang, you're here." I still have headaches, and I always feel heavy, as if I am being blistered. ”
Director Zhang gently patted Uncle Li's hand to show comfort, and then turned to Dr. Xiaolin and said, "Xiaolin, you analyze, why the effect of mannitol is not ideal, and what options do we have?" ”
Dr. Kobayashi was a little flustered, but still tried his best to answer: "Director, I think it may be that the amount of mannitol has been large, and the patient's kidney function has begun to be affected. I thought about using glycerol fructose, but I wasn't quite sure about its effects and indications. ”
Director Zhang nodded with satisfaction, as if he affirmed Xiao Lin's thinking, but then changed his words: "Okay, then I'll test you." What is the difference between mannitol and glycerol fructose in lowering cranial blood pressure? Why in this case, we might consider switching to glycerol fructose? ”
Dr. Kobayashi took a deep breath and tried to recall what he had learned: "Mannitol has a fast onset of action and is suitable for emergency treatment, but it is mainly excreted by the kidneys, which may affect kidney function. Fructose, on the other hand, has a slower onset of action, but it does not increase the burden on the kidneys and can still provide energy, which is suitable for patients with chronic intracranial hypertension and renal insufficiency. ”
"Very good, very comprehensive answer." Director Zhang approvingly, and then turned to Uncle Li, "Uncle Li, what about your situation, you really need to adjust the treatment plan. Although mannitol has a fast onset of action, long-term use in large quantities is a big burden on the kidneys. As for glycerol fructose, it works a little slower, but it is mild and long-lasting, and it is also more kidney-friendly. We're going to give it a try, what do you think? ”
When Uncle Li heard this, he nodded hurriedly: "Director Zhang, you can change it as you say, as long as it can make me get better quickly, I am willing to try!" ”
Director Zhang smiled, and then arranged a new treatment plan: "Xiaolin, you prepare, from today onwards, we will replace Uncle Li with glycerol fructose, the initial dose should be controlled, and at the same time monitor his kidney function and intracranial pressure changes." Remember, treatment needs to be individualized and not one-size-fits-all. ”
Dr. Kobayashi nodded again and again, secretly glad that he could learn such a valuable experience in such a practical battle.
In the next few days, Uncle Lee's treatment plan was successfully adjusted, and the application of glycerol fructose really brought different results. His intracranial pressure gradually stabilized, his kidney function did not deteriorate further, his headache symptoms were significantly reduced, and his mental state was much better.
At a discussion meeting after ward rounds, Dr. Kobayashi was full of emotion: "Director Zhang, this time I am really thanks to your guidance. I always thought that mannitol was a 'panacea' for lowering cranial pressure, but I didn't expect glycerol fructose to be more advantageous in some cases. ”
Director Zhang smiled and shook his head: "Medicine is an art that needs to be continuously studied and practiced. Each drug has its advantages and disadvantages, and the key is to choose the most appropriate regimen according to the specific situation of the patient. Remember, there is no such thing as the best medicine, only the best one. ”
This ward round not only allowed Uncle Li's condition to be effectively controlled, but also gave Dr. Kobayashi a deeper understanding and experience of the choice of intracranial pressure lowering drugs. On the road of medicine, every challenge and failure is a stepping stone to growth, and Director Zhang's words and deeds are undoubtedly the most valuable beacon on their way forward.
On the battlefield of neurology, every battle with disease is a test of medical skills and wisdom. The choice of mannitol and glycerol fructose may seem simple, but it actually contains deep medical knowledge and an accurate grasp of the individual differences of patients.
Mannitol VS glycerol fructose
Through Director Zhang Chenguang's ward rounds, we not only witnessed the improvement of Uncle Li's condition, but also learned valuable knowledge about intracranial blood pressure lowering drugs. The following is a summary of several key points in the application of mannitol and fructose glycerol in lowering intracranial pressure:
1. Pharmacological effects:
Mannitol and fructose glycerol are both hypertonic solute diuretic dehydrating agents that reduce edema by increasing plasma osmolality and promoting the entry of tissue water into blood vessels.
2. Onset time and duration of action:
Mannitol has a rapid onset of action, and the effect of reducing intraocular and intracranial pressure occurs within 15 minutes after intravenous injection, and the peak time is 30-60 minutes, which can be maintained for 3-8 hours.
Fructose glycerol has a slow onset of action and reaches equilibrium in the body within about 2-3 hours after intravenous administration, but the effect is long-lasting.
3. Excretion and metabolism:
Mannitol is mainly excreted by the kidneys and has a certain effect on kidney function.
The fructose in fructose glycerol can provide energy, enter the brain tissue through the blood-brain barrier for oxidation, and its metabolic process does not require insulin, which has less burden on the kidneys.
4. Indications and contraindications:
Mannitol is suitable for emergency rescue, such as massive cerebral infarction, acute intracranial hypertension caused by cerebral infarction combined with hemorrhage, or critical situations in which cerebral herniation occurs.
Fructose glycerol is suitable for chronic intracranial hypertension, cerebral edema, cerebral thrombosis, intracerebral hemorrhage and other encephalopathy, especially for patients with renal insufficiency.
5. Combination drug strategy:
Sequential use of mannitol in combination with glycerol fructose is recommended to reduce the amount of mannitol, reduce its effects on renal function and electrolytes, and avoid intracranial pressure rebound.
Through this round, we not only learned professional knowledge, but also realized the importance of personalized treatment in medical practice. Each drug is unique in its own way, and the key is to be flexible in its choice and application according to the patient's specific situation. This is the charm of medicine, and it is also the direction that we as doctors continue to pursue and learn.