Chapter 739: Thiocyanate Poisoning
Huang Dazhi’s doubts about the surgery did not lie in the diagnosis but in the technique.
Zheng Ren could demonstrate the technique. As for how it should be used in surgery, it would depend on that individual’s comprehension.
Even if Zheng Ren did not hide anything, most people would not be able to understand it.
Professor Huang asked for advice on two more difficult methods to select and remove the suppository. After Xie Yiren finished the handover, she walked out.
He knew that this was not a good time to chat, so he brought Zheng Ren and the others to the intervention department with a smile.
On the way, Professor Huang did not say anything more because Zheng Ren and Su Yun were about to fall asleep. He was just being careful not to let them fall asleep, hurt themselves, or get others hurt along the way.
After entering the ward, Professor Huang came to the door of the chief’s office and said with a smile, “The chief specially left the door open for you. He said that if you need anything, you can come and rest anytime.”
“Thank you,” Zheng Ren faintly said.
Suddenly, there was a burst of hurried footsteps in the corridor and the loud sound of wheels rubbing against the ground.
Subconsciously, Zheng Ren opened his eyes. In a daze, he thought that he was in Sea City General Hospital.
“What’s wrong?” Zheng Ren asked in a daze.
“Boss, it seems to be resuscitation.” Su Yun was also in a daze. He guessed when he saw the nurse pus.h.i.+ng the stretcher trolley into the ward.
“Let’s go take a look.” Zheng Ren also saw the situation clearly and immediately became more energetic.
Xie Yiren wanted to say something but after hesitating for a moment, she finally let Zheng Ren go.
She originally wanted to take a look at where Zheng Ren was sleeping and then drive around to see what food she could buy.
She did not expect for there to be a resuscitation immediately after getting out of the ward.
Zheng Ren strode into the ward and saw a patient’s hands and feet twitching slightly. He wanted to move but was unable to do so. He was mumbling something, but the words were unclear.
The nurses, doctors, and volunteers who acted as nurses were rescuing the patient in front of the bed. They couldn’t see the patient, so the System panel didn’t give a diagnosis for the time being.
“Boss, this person is probably a programmer. He talks about code in his sleep. He’s really dedicated,” Su Yun said in a low voice.
“Programmer?”
“According to his delirium, that should be the case,” Su Yun said.
“Isn’t this a postoperative patient? What happened?” Professor Huang was a little surprised and quickly asked.
“Professor Huang, the patient underwent blood transfusion after the stent operation. He was hypotensive and showed symptoms such as movement disorder, blurred vision, and so on. Then, he began to suffer from delirium, dizziness, headache, accompanied by nausea and vomiting. The vomit was gastric contents,” the doctor reported.
“Stent?” Zheng Ren was stunned for a moment.
The current patients were basically those with hemorrhagic shock. A blood transfusion would be more than enough. Generally, there was no blood pressure reduction.
With the addition of the stent, Zheng Ren immediately remembered that he had diagnosed a patient with an abdominal aortic dissection when he first arrived.
That patient had been given a stent, so Zheng Ren was sure that there would be no problems with the stent operation. His own surgical experience and the surgical progress bar given by the System could prove it.
What was going on?
He took a step forward and saw the patient while the volunteer went to get something.
The diagnosis given by the System’s panel at the top right of his field of vision was—pelvic fracture after interventional embolization, abdominal aortic dissection aneurysm after stent surgery, thiocyanate poisoning.
He was so sleepy that he was confused. Zheng Ren had misread the diagnosis.
His first reaction was cyanide poisoning!
That was a big deal. Could it be that someone had poisoned him?
Zheng Ren was so scared that he quivered and ‘woke up’.
Then, he saw clearly that it was thiocyanate poisoning. His mind quickly recalled what it was and his expression changed slightly.
Su Yun saw that Zheng Ren’s condition was not right, so he squeezed forward and asked, “What’s wrong, Boss?”
“Nothing.” Zheng Ren shook his head. He could not tell Su Yun about cyanide poisoning. If he did, this fellow would simply talk about it until the next year.
“It’s a postoperative patient of the abdominal aortic dissection aneurysm that I did, right?” Zheng Ren asked.
“Yes, Teacher Zheng. “Professor Huang felt the powerful aura of a senior doctor, so he subconsciously called him teacher.
“What was done to lower the blood pressure?” Zheng Ren asked.
Even after the operation on an aortic dissecting aneurysm, one had to maintain stable blood pressure. It would be fine once the rupture was completely blocked by the peritoneal shelf. Normally, one had to give blood pressure medicine for one to two days before it could be stopped. There was nothing special about it. It was all routine treatment.
“Sodium nitroprusside, micro-pump it in. The dosage is 8 μg/kg/min.” The junior doctor immediately reported the dosage.
Zheng Ren then knew what had happened.
He said in a deep voice, “Stop the sodium nitroprusside. Contact the nephrology department immediately and go for dialysis.”
Professor Huang was stunned. What was this operation? Acute renal insufficiency? Under normal circ.u.mstances, the performance of renal insufficiency was on the urine volume and this patient’s urine volume was normal.
Although the urine volume was low due to hemorrhagic shock, it was not below the level of 50ml per hour for renal insufficiency.
He had his doubts but when he heard Zheng Ren’s words, he immediately stopped the micro-pump and started pumping sodium nitroprusside.
“There’s no need to give too much treatment. Just be careful not to accidentally aspirate the vomit and suffocate the patient,” Zheng Ren said.
Professor Huang was puzzled. He arranged for the junior doctor to immediately contact the nephrology department. He came to Zheng Ren’s side and asked, “Professor Zheng, is it acute kidney failure?”
“Sort of,” Zheng Ren replied.
He was sweating… What sort of answer was that?
For the first time, Professor Huang felt that Zheng Ren was a little unreliable. However, this kind of thought was nipped in the bud as soon as it appeared.
Zheng Ren was a candidate for the n.o.bel Prize. His ident.i.ty alone could solve many problems.
That was not all. He had personally witnessed the surgery. He was definitely the most awesome doctor he had ever seen. Usually, doctors like him had a lot of clinical experience.
His own suspicions could only prove that he had little clinical experience and his diagnosis was wrong.
Professor Huang looked at Zheng Ren with an inquiring gaze and waited for his explanation.
“It’s thiocyanate poisoning,” Zheng Ren said.
Uh… It was common practice to use sodium nitroprusside in the clinic. Many patients had high blood pressure and needed to use sodium nitroprusside to control it. For so many years, Professor Huang had rarely heard of the diagnosis of thiocyanate poisoning.
It was not rare, but cases were almost nil.
Thiocyanate poisoning sounded so strange to him.
“It’s the metabolism of sodium nitroprusside, right?” Su Yun immediately thought of some possibilities and asked.
“Yes,” Zheng Ren said. “Sodium nitroprusside is a kind of nitro-hydrocyanate, a strong dilator that acts directly on the vascular bed of arteries and veins. Sodium nitroprusside was continuously pumped in. First, it was converted from erythrocyte to cyanide, and then from thiocyanate in the liver to thiocyanate, the end metabolite.
“Thiocyanate was excreted from the kidney. The half-life of a person with normal kidney function is four to seven days. Patients with kidney failure have an acc.u.mulation. If the dosage is too high, poisoning is normal.”
“But the patient has no abnormal kidney function,” Professor Huang said as he tried to recall the patient’s test results.
“There wasn’t before, but now there is.”