Chapter 716: Chapter 293: Diagnosis of an Extremely Difficult Case, Du Leng Picking Peaches_2
"Has the patient had a urine test?"
"Here is the latest urinalysis report." Yang Chan proactively handed over the urinalysis result to Zhou Can.
After receiving it, Zhou Can looked it over, then checked the patient’s other biochemical test data.
"Urine ketone body positive, blood gas suggests metabolic acidosis, so she must have ketoacidosis, right?"
Zhou Can concluded after reviewing the data.
"Director Zhang and the experts have already provided this diagnosis just now."
Yang Chan answered.
"Now we need to consider why the patient developed a consciousness disorder, even a coma, after stopping her medication and switching to traditional Chinese medicine?" Director Zhang pointed out the problem that Zhou Can needed to address.
The experts had some conclusions after their recent discussion.
However, opinions may differ to some extent.
"Analyzing the patient’s symptoms and test data, I believe her illnesses need to be treated separately. The cause of the consciousness disorder, even leading to a coma, is not necessarily related to the intake of traditional Chinese medicine; she likely has hyperosmolar coma."
Zhou Can’s mind was exceptionally clear during the diagnostic process, with a clear train of thought.
"Hyperosmolar coma often occurs in elderly patients, but she is only in her thirties, still very young. I personally think the likelihood of hyperosmolarity is small."
Director Luo, somewhat snobbish, disagreed with Zhou Can’s diagnostic opinion.
"No absolute certainty exists in this world, this patient’s situation is quite special. My diagnostic approach is this: the patient was previously taking Miconing, and only after she stopped the medication did the symptoms of diabetes insipidus worsen, resulting in dehydration. Then she also stopped taking her antidiabetic drugs, switching to traditional Chinese medicine. This caused her blood sugar level to rise and, inevitably, worsened the dehydration, ultimately leading to a hyperosmolar coma. Ketoacidosis is also triggered by discontinuing the antidiabetic drugs."
Zhou Can made a detailed analysis of the patient’s pathophysiological mechanisms and the associated pharmacological mechanisms.
[Pathology Diagnosis Experience Points +1, Pharmacological Differentiation Experience Points +1. You have successfully diagnosed a difficult case, earning 100 Experience Points for both pathology and pharmacology.]
The Experience Points are already accounted for, indicating that Zhou Can’s diagnosis was entirely correct.
This illness’s diagnosis within five days was not particularly difficult.
Mainly because it has multiple symptoms, the situation is complex, like tangled hemp — to diagnose the pathology correctly, one needs to sort them out one by one.
By treating amenorrhea, polydipsia, and consciousness disorders separately, Zhou Can significantly reduced the diagnostic difficulty.
And so, he could avoid interference from other pathological mechanisms.
"Well said! I think the diagnosis of hyperosmolar coma for the patient is entirely correct." Director Zhang firmly supported this diagnostic conclusion after listening to Zhou Can’s analysis.
"Alright, even if the patient’s consciousness disorder is due to hyperosmolar coma, what about her polyuria?"
Director Luo compromised.
Having to agree with Zhou Can’s diagnosis, she then raised a new question.
"Don’t worry, let’s address each issue separately. Analyzing the patient’s polyuria and polydipsia from her test data and her actual condition, we can basically confirm the diagnosis of diabetes insipidus. And it belongs to Central diabetes insipidus."
Zhou Can’s approach of separating and dealing with issues one by one certainly was refreshing for many doctors.
Many doctors are used to a fixed mindset, thinking that although a patient may have many symptoms, there usually is only one cause. Identifying that cause and treating it accordingly is expected to cure the illness.
In reality, it’s often exactly like that.
But there could also be the possibility of one symptom with multiple illnesses or multiple symptoms with multiple diseases.
In clinical practice, it is very common for a patient to have several underlying diseases at the same time, such as hypertension, diabetes, and nephritis.
However, these common underlying diseases are very easy to diagnose.
For hypertension, measuring the blood pressure is enough.
For diabetes, checking the blood sugar and urinalysis will suffice. Even for a more complex case of diabetes, further liver and kidney function tests along with lipid and pancreatic function assessments can clarify the diagnosis.
These diseases typically have definitive diagnostic gold standards, making them easy to identify.
However, the patient at hand has an elusive cause. Type 2 diabetes is just an apparent cause, but due to the patient’s trust in the recommendations of relatives, discontinuing Western medicine to take traditional Chinese medicine, her condition has worsened, clearly involving more than one cause.
If one still focuses on diagnosing and treating around diabetes, they will undoubtedly end up like the doctors from the previous hospitals, utterly unable to cure the disease.
"Based on the results of the patient’s water deprivation and desmopressin test, the diagnosis of Central diabetes insipidus stands to reason." Director Jiang of the Neurology Department supported Zhou Can’s diagnostic opinion.
So many experts gathered here for a joint diagnosis of this woman’s condition, attracting many family members and other patients to gather around.
Apart from finding it unusual, they also wanted to see which expert was more competent.
They also wanted to see exactly how experts diagnose illnesses.
The patient’s water deprivation-desmopressin test revealed that after stopping desmopressin twice (i.e., the Miconing medication she often took), after an eight-hour water restriction, the blood osmolality was at 330 MOSM/L and urine osmolality at 103 MOSM/L. After injection of pituitary posterior hormone, the urine osmolality rose to 590 MOSM/L.
A saddle area MRI discovered an enlarged pituitary stalk and, surprisingly, the high signal from the pituitary posterior lobe had disappeared.
It was these key test data that led Zhou Can to determine that the patient had Central diabetes insipidus.
"So what exactly caused Central diabetes insipidus? Was it caused by Type 2 diabetes?" Yang Chan wasn’t afraid to ask since she was unfamiliar, besides Zhou Can was her classmate.