Back in 2002 as a doctor

Although Zhou Congwen explained in detail, Lu Tiancheng didn't understand.

In this regard, he is no different from Boss Chunxiao who is like Bai Ding.

Medicine is more and more subdivided, and specialists only have a general understanding of diseases in other departments, and it is difficult to go deep.

Monsters like Zhou Congwen are rare.

"Licorice can prevent the inactivation of cortisol and aldosterone in the liver, resulting in pseudo-aldosterone effects, resulting in hypokalemia."

"Severe hypokalemia causes intracellular potassium outflow, and cells cannot release enough potassium to dilate blood vessels during muscle contraction, resulting in insufficient blood supply to skeletal muscle, ATP depletion in muscle cells, and ischemic necrosis leading to rhabdomyolysis."

"Licorice tablets have aldosterone-like effects and can also cause high blood pressure. Such patients are most likely to be misdiagnosed, and a detailed medical history is very important."

After Zhou Congwen finished speaking, he looked at Boss Chunxiao, and then at Lu Tiancheng.

The two look normal.

"Let me give you an example." Zhou Congwen laughed. He knew that simple and boring medical knowledge is the best hypnotic.

Not to mention Boss Chunxiao, even an old clinician like Lu Tiancheng has no awareness of the pseudoaldoketosis induced by licorice.

If I talk about pure theory again, I am afraid that both of them will fall asleep.

"My... my boss once saw a patient."

"The youngest Huang from Imperial Capital 912?" Boss Chun Xiao interrupted and asked.

Zhou Congwen nodded.

"I know, I've heard people say it. Now when the doctors of the Third Hospital talk about you, they say that you've got shit luck, your family's ancestral grave was struck by lightning, Mr. Huang..."

Saying that, Boss Chunxiao scratched his head in embarrassment.

It is indeed a bit inappropriate to say this in front of Zhou Congwen.Boss Chunxiao was quite embarrassed because he was too excited and said the wrong thing just now.

Zhou Congwen didn't care, but smiled, "A 51-year-old male patient wants to quit smoking for health reasons."

"..."

Both Lu Tiancheng and Boss Chunxiao were stunned.

Didn't you talk about aldosterone? How did it get involved in quitting smoking?

But the two of them did not interrupt Zhou Congwen's words, but listened intently.

"Three months after quitting smoking, I went to the emergency department of a community hospital because of abdominal pain for 3 days, anorexia, vomiting, and diarrhea for 3 day. I complained of dry mouth and polydipsia recently, but no symptoms of polyuria and limb weakness."

"What does Nacha mean?" Boss Chunxiao asked without understanding.

"The so-called 'Na' refers to 'stomach satisfaction', and 'Na poor' means reduced food intake. In the category of traditional Chinese medicine, it is classified as spleen and stomach disease, which is caused by many reasons."

"Oh oh oh, a lot of what your doctors say is like black talk." Boss Chun Xiao laughed.

"There's a lot more, listen to my story first." Zhou Congwen said.

"At the time of admission to the hospital, the vital signs were stable, but the blood pressure was high. Usually, the patient has no history of high blood pressure, and he thought it was caused by abdominal pain. The patient's stomach is fine, and it doesn't hurt when pressed." Zhou Congwen tried his best to use what Boss Chunxiao could hear. Tell what you understand.

"Like the patient in front of me, that patient also had hypokalemia. The admission diagnosis was gastroenteritis and hypokalemia. But after admission, the abdominal pain relieved, but the blood pressure was still above 170."

"That's high enough." Boss Chunxiao murmured.

"What? Your blood pressure is also high?"

"No, a buddy won 10 yuan a while ago, because he was too excited to suffer from high blood pressure and cerebral hemorrhage on the spot." Boss Chunxiao sighed, "Fortunately, my place is close to our third hospital, and I was sent for emergency treatment immediately. For surgery, 10 yuan is not enough.”

"..." Zhou Congwen didn't expect Boss Chunxiao's life to be so rich.

Lu Tiancheng was speechless.

He even began to think about buying lottery tickets with Boss Chunxiao.

"I will continue." Zhou Congwen said, "Because the blood pressure has been high, the possibility of hyperaldosteronism is suspected, and serum aldosterone, renin activity, cortisol tests and abdominal CT examinations will be performed."

"But nothing was gained, and their doctors didn't know what rare disease they encountered, so they asked the boss for consultation."

"What did Huang Lao say?" Lu Tiancheng became interested.

Almost identical cases, are high blood pressure, hypokalemia, alkalosis.But considering that it shouldn't be caused by the licorice tablets, he was very curious about what Huang Lao would do.

"Ask about the medical history, the boss sat by the bed and chatted with the patient for a long time. My boss smoked the white ganoderma lucidum all his life, and the patient has been eating sugar all the time."

"At first, the boss didn't care. It's normal for patients who quit smoking to eat candy, but he later found out that this candy has a name - licorice-flavored black jelly beans."

"I'll go!" Lu Tiancheng was surprised, "Licorice-flavored candy doesn't even work?"

"It's the real thing." Zhou Congwen said with a smile, "it's indeed made of licorice, and the taste is not an industrial additive. The patient ate 50 pills a day, so something happened."

"!!!"

Chapter 1267

"Doctor Zhou, then I'll go and talk to them." Boss Chunxiao listened to Zhou Congwen's story at the end, and he finally understood what it meant.

Although he is still not very convinced, Boss Chunxiao just doesn't believe that Licorice will have such a big reaction, but it's not that he doesn't believe Zhou Congwen.

"Go."

"Stop the compound licorice tablet, and then you'll be fine?" Boss Chun Xiao finally confirmed.

Zhou Congwen nodded.

Seeing the back of Boss Chunxiao walking into the gate of the emergency room of the Third Hospital, Lu Tiancheng was in a daze.

He is a doctor, and vaguely knows that the licorice-flavored black jelly beans are related to high blood pressure, hypokalemia, and alkalosis, but he can't get in touch.

"Professor Zhou, can you tell me?" Lu Tiancheng humbly asked for advice.

"Hehe, are you really planning to switch careers to become a physician?" Zhou Congwen laughed.

But with just one sentence, Zhou Congwen began to tell Lu Tiancheng.

"Normally, cortisol is oxidized by type II 11β hydroxysteroid dehydrogenase to produce inactive cortisol.

Cortisol is similar to aldosterone, it can bind to mineralocorticoid receptors in the kidney, participate in the renin-angiotensin-aldosterone system, and play a role in maintaining body fluid and electrolyte balance, but this effect is relatively small compared to aldosterone . "

"Because glycyrrhizic acid can inhibit the activity of 11β-HSD2, long-term intake of large amounts of licorice preparations by patients can make the concentration of cortisol much higher than that of aldosterone.

The subsequent consequence is that cortisol is dominant in binding to mineralocorticoid receptors, causing water and sodium retention, decreased blood potassium, increased blood pressure, and inhibition of renin and aldosterone synthesis and secretion. "

“一般持续食用大量甘草3-10天即可引起水钠潴留、血压升高，2周内血压升高达到最大值。停用甘草后，甘草酸抑制11β—HSD2效应可能会持续2-4周。”

While explaining the principle to Lu Tiancheng, Zhou Congwen drew an extremely cumbersome sketch on the ground with a branch.

Lu Tiancheng even felt that Zhou Congwen was drawing talismans on the ground like a dragon and tiger celestial master.

When he was finished, he slapped the talisman on the sick man's forehead, and the sky would collapse.

"Glycyrrhizic acid and its derivatives can significantly inhibit the activity of lipoxygenase and cyclooxygenase, thereby inhibiting the synthesis of prostaglandins;

In addition, it can also inhibit the synthesis and release of histamine.Due to the reduction of active substances that relax blood vessels, the resistance of blood vessels increases, so blood pressure rises. "

"In foreign countries, pseudoaldosteronism caused by licorice intake is often caused by eating desserts containing licorice.

Domestically, it is mainly Chinese patent medicines that take or intravenously infuse licorice and glycyrrhizic acid preparations.

Once pseudoaldoketosis is diagnosed, as long as the licorice preparation is stopped in time, potassium supplementation is reasonable, aldosterone antagonists are used, and antihypertensive and other symptomatic treatments are used, the prognosis is generally good. "

"Actually, you don't need to listen to me rambling on about the principle. You are not a nephrologist or endocrinologist, so you don't need to know at all."

Hearing what Zhou Congwen said, Lu Tiancheng felt a bit of slander in his heart.

I'm not, you are?How can you, a thoracic surgeon, know so many messy things.

What is Jiaxing aldosteronism, should thoracic surgeons know about it?

"The symptoms are very simple, such as high blood pressure, hypokalemia, and alkalosis. Check to see if the patient has taken licorice-based preparations. If so, just stop the medicine."

"Then I know." Lu Tiancheng nodded.

Zhou Congwen put down the branch, suddenly remembered something, and laughed.

"Professor Zhou?" Lu Tiancheng looked at Zhou Congwen suspiciously.

"Water Margin, have you seen it?"

"..."

"Pan Jinlian feed Wu Dalang medicine, Dalang, it's time to take medicine." Zhou Congwen laughed.

Lu Tiancheng shivered subconsciously, his whole body was terrified.

Although Zhou Congwen didn't say it clearly, he immediately thought of a possibility - desserts containing licorice.

If you really want to do something, this thing is a sharp weapon that kills people invisible.

Moreover, looking at the whole country of pseudoaldosteronism, there may not be many doctors who can correctly diagnose it.

At that time, as long as the dosage is continuously increased...

Thinking about it, Lu Tiancheng shuddered.

"Director Deng has a friend." Zhou Congwen said, "There was a conflict between the couple. The man wanted to kill him, so he bought a lot of licorice-flavored candy and kept it at home. He didn't let the women eat it, but it was a delicious dessert after all. , so women quickly become addicted to it.”

"I go……"

"This is all guesswork after the fact. Director Deng only knows a few pieces of the scaly claws." Zhou Congwen said, "When the woman passed away, Director Deng was still helping with the work, and saw a lot of licorice-flavored candies at home."

"It wasn't until a small talk that the boss pointed out the whole story, saying that the man probably did it on purpose, and Director Deng suddenly realized."

"..." Lu Tiancheng was speechless.

According to Zhou Congwen, even if this matter is discovered, it is absolutely impossible to be accused, let alone sentencing.

"I'm just gossiping casually." Zhou Congwen said with a smile, "If you meet someone in your life who wants to give you licorice candies, be careful."

"Professor Zhou, you...you really know how to joke."

"It's not a joke, it's just a possibility of casual gossip." Zhou Congwen said, "There are many things that kill people invisible, such as..."

He only said one beginning, then looked at Lu Tiancheng and said with a smile, "I won't say more, I'm afraid I'll spoil you if I talk too much."

"Hahaha." Lu Tiancheng smiled, but there was some fear in his smile.

Professor Zhou Congwen Zhou knows a lot. A licorice preparation and licorice candy can kill people invisible.

Thinking about it, Lu Tiancheng suddenly asked suspiciously, "Professor Zhou, what about compound licorice tablets?"

“复方甘草片是复方制剂，组份为每片含甘草浸膏粉112.5毫克、阿片粉4毫克、樟脑2毫克、八角茴香油2毫克、苯甲酸钠2毫克。”

"Because it contains opioid powder, it is easier to become addicted. The licorice candy I said is second. Once the compound licorice tablet is addictive, it will be a big problem."

"For example, this patient." Zhou Congwen looked towards the emergency department of the Third Hospital, "Whether you can quit or not is the same thing. Those fake genius doctors are really harmful."

Lu Tiancheng was in a very complicated mood.

Originally, he was very happy to work with Academician Chu, but the only entanglement was that he would suddenly become a physician in the future.

But there are academicians around, so what's the point of being hypocritical?

But after Zhou Congwen said so much, Lu Tiancheng knew that no matter what kind of doctor he was, he could only say that he was amazing.

The drug content of Compound Licorice Tablets can be easily read by him, and various cases can be found at his fingertips.

Looking at Zhou Congwen's young face, Lu Tiancheng's heart was surging.

The last entanglement was left behind by Lu Tiancheng, and he felt that he had a promising future!

Chapter 1268 Chance

Lu Tiancheng thought of some patients he met when he was out of the emergency room. The patients felt that there was nothing wrong with them, and they hurriedly went back when they got better.

If you really want to eat this kind of powder of compound licorice tablets continuously, you really can't say what will happen in the end.

Just like what Zhou Congwen said, killing people is invisible.

"Professor Zhou, you...you..."

Lu Tiancheng stammered and didn't know how to ask.

"How do I know?" Zhou Congwen said with a smile.

Lu Tiancheng nodded.

"It's written in the book."