Often, it is a sign that a severe illness is approaching.
Zhou Can looked up at the patient sitting there, whose family member was likely the patient’s mother. She was about fifty years old, had dark skin from sun exposure, and her hands were large and rough.
This is a woman who has had a hard life.
"Yes, yes, it’s my son who is ill, please doctor, take great care." The patient’s mother was a straightforward kind of woman. She did not disrespect Zhou Can for his youth but showed the same respect and courtesy.
Instead, the young patient himself did not seem to hold much hope for Zhou Can.
After all, Zhou Can was very young. Even younger than this patient.
"Have you checked the physical examination?"
Zhou Can asked Director Zheng.
The hospital physical examination actually covers a lot of information. It includes the patient’s state when visiting, whether they were carried or walked in, as well as their body posture, and the measurement of basic vital signs.
Visually, the patient was slightly thin, but not frighteningly so.
Zhou Can had seen patients in the Intensive Care Medicine Department, skeletal with just skin wrapping their bones—now that was truly frightening.
"The physical examination has already been completed. The patient’s physical examination data, chief complaint, medical history, and other information are all recorded here."
Director Zheng handed Zhou Can the medical record.
Upon admission, the patient was lightly underweight, clear-minded, with normal blood pressure, respiration, and pulse. No abnormalities found in the heart and lungs, and the abdomen was soft upon palpation without any noticeable lumps. No shifting dullness in the abdomen, no edema on the lower limbs.
Some patients with severe diarrhea may have tight abdominal muscles, or a distended abdomen due to fluid accumulation.
When pressing, these patients’ abdomens tend to be harder.
This patient’s belly was soft upon pressing, immediately excluding many possible causes.
Zhou Can continued to review the tests the patient had undergone.
Laboratory tests done at another hospital included routine blood and urine exams, and routine stool test, and biochemical blood test.
Plenty of tests were done, but the patient’s overall data revealed no significant abnormalities.
This included normal results for sugar, protein, and microscopic examination in urine routine. The specific gravity was low, only about 1.0004.
The patient had also undergone a stool routine, bacterial culture, and Sudan III staining at another hospital, all showing negative results.
Ultimately, this major hospital gave a diagnostic opinion of "Functional Diarrhea."
They also suspected Diabetes Insipidus due to clinical symptoms of excessive drinking, excessive urination, and low specific gravity urine.
Speaking of diabetes insipidus, it is divided into three types: central diabetes insipidus, nephrogenic diabetes insipidus, and dipsogenic diabetes insipidus.
The patient’s clinical manifestations included hypokalemia, with blood potassium levels between 2.2—2.8. So, had this major hospital concluded nephrogenic diabetes insipidus?
A question mark signifies doubt—the admitting doctor feared being proven wrong and couldn’t confirm it with certainty.
Thus, a question mark means awaiting further verification.
This major hospital documented the patient’s 24-hour urine volume, a staggering 11000ml.
That’s a shocking amount of urine—one bottle of mineral water is 550ml, the patient could fill up 20 bottles with his daily urine output.
To ascertain the cause of the patient’s hypokalemia, this major hospital conducted a potassium balance test and had the patient fast for three days, daily infusing 3g of potassium chloride.
On the third day, they rechecked blood potassium, urine potassium, and fecal potassium; blood K was 3.3mmol/L, urine K 14mmol/day, and fecal K 32mmol/day.
A normal person ingests 100mmol of potassium daily, and the gastrointestinal tract can almost completely absorb ingested potassium.
The kidneys are the main organs regulating potassium balance in the body, about ninety percent of potassium is excreted through the kidneys.
A normal person’s fecal potassium is less than one-tenth of their intake.
This patient’s fecal potassium significantly exceeded the standard by more than three times, indirectly proving renal insufficiency.
The causes of hypokalemia are few, such as insufficient potassium intake, excessive loss from vomiting, or potassium ions shifting from the extracellular to the intracellular space.
This patient, aside from diarrhea, did not exhibit symptoms of vomiting; this could be ruled out first.
Next, the patient’s dietary intake was largely normal, so insufficient potassium intake could also be excluded.
That left only the third possibility, potassium ions shifting from the extracellular to the intracellular.
Common causes of intracellular and extracellular potassium imbalance include four factors.
One, acid-base balance. Two, insulin. Three, aldosterone. Four, sympathetic nerve activity.
This case is like a major test of human internal medicine science, no wonder Director Zheng needed Zhou Can’s help.
Yet, he didn’t know that although Zhou Can was proficient in diagnosing, his foundation in medicine was not profound.
It was only in these past two years, after cramming a lot of basic medical knowledge, that he could barely handle this case analysis.
In order to clarify the cause of the patient’s intracellular and extracellular potassium imbalance, Zhou Can once again reviewed the patient’s multiple test data.
After thorough investigation, he finally diagnosed that the patient’s hypokalemia was caused by the first factor, acid-base balance.
More accurately, it should be said to be alkalosis.
[Pathological diagnosis +1.]
[You have first diagnosed a highly inferential complex pathological mechanism, reward pathological diagnosis +100.]
This was his first time earning pathological diagnosis experience points and a high-value reward without diagnosing the complete etiology.
Diagnosing this case also greatly benefits Zhou Can.
It activated many of the basic medical knowledge he had learned, bringing it into practical use.
"Dr. Zhou, have you discovered anything?"