Chapter 291: The Sequelae of Ceftriaxone

"The patient has small stones, but the stones are not enough to affect urination," Liu Zhuren said with certainty. "Xu Zhuren, I see that the renal function is not particularly poor; why not try dialysis for a few days?"

"I just can't understand why," the Department of Nephrology's Xu Zhuren said, frowning. "I know it has nothing to do with you all, but..."

She spoke, then stopped mid-sentence.

This consultation was indeed somewhat nonsensical, but Xu Zhuren had no other choice; she could only try it and see if Liu Zhuren from the Urology Department had any ideas.

"It has nothing to do with us," Liu Zhuren smiled and repeated.

No sooner had the words left his mouth than Liu Zhuren suddenly felt his foot being lightly kicked.

It was Ji Xiang!

He was reminding him!!

Liu Zhuren was startled. Realizing there might be a problem, he immediately recalled the patient's imaging data, past medical history, and current targeted treatment.

There was nothing wrong; this patient had absolutely nothing to do with the Urology Department!

However, he remained calm, stood up, and said, "Then let's leave it at that for now; I'll go back and think it over."

"Thank you for your hard work, Liu Zhuren. Please write up the consultation notes."

"Mm, alright."

Liu Zhuren and Ji Xiang left the Department of Nephrology. As soon as Xu Zhuren's figure disappeared, Liu Zhuren immediately asked, "Xiao Ji, what is your take on this?"

"Zhuren, the patient used Ceftriaxone at the local hospital," Ji Xiang said in a low voice.

"Ceftriaxone? There's nothing wrong with that. It's a broad-spectrum antibiotic that works against Staphylococcus aureus, Streptococcus, and Pseudomonas aeruginosa. Using it at the time was considered symptomatic treatment."

Liu Zhuren still didn't know what Ji Xiang was trying to say.

"Zhuren..." Ji Xiang also didn't know how best to put it.

"Xiao Ji, if you have something to say, just say it. Don't feel inhibited just because I'm a Zhuren," Liu Zhuren tilted his head slightly and looked at Ji Xiang earnestly.

"The drug insert for Ceftriaxone Sodium mentions the extremely rare possibility of gallstones."

"..." Liu Zhuren was stunned; he knew absolutely nothing about this.

Ceftriaxone Sodium is a commonly used clinical drug with excellent efficacy, but this drug can also form gallstones?

Liu Zhuren was dumbfounded.

"Theoretically, Ceftriaxone Sodium has high drug solubility and does not easily form urinary tract stones.

When blood volume decreases, urine flow rate drops, and high-dose medication is used, the drug concentration reaches a peak in a short time.

Ceftriaxone ions form Ceftriaxone Calcium with calcium ions in the urine. Because Ceftriaxone Calcium is poorly soluble in water, it precipitates as crystals in the ureteral urine, forming pseudo-stones, leading to acute urinary tract obstruction, which in turn causes acute renal failure." (Note)

Ji Xiang repeated the theory the System NPC had told him word for word.

In truth, Ji Xiang wasn't very sure either; the System NPC's theory was too bizarre. That an antibiotic could cause renal failure was something Ji Xiang didn't quite understand.

Liu Zhuren listened, completely bewildered.

But Liu Zhuren had already been "conquered" long ago; starting from the Cavernous Body Puncture, the subsequent string of unfathomable cases left Liu Zhuren unable to muster any desire to question him.

"How do we diagnose it?" Liu Zhuren asked with a frown.

"Animal experiments and in vitro experiments show that the formation of Ceftriaxone stones is positively correlated with the concentration of calcium ions and Ceftriaxone in the urine, and negatively correlated with the concentration of Citric Acid in the urine."

"But for the examination, I'm afraid our Second Affiliated Hospital doesn't have it. It's better to take a look with an Endoscope."

Ji Xiang suggested.

"Alright." Liu Zhuren turned around and, after hesitating for a moment, picked up his phone.

"Gao? It's me, Liu Zhi. Help me take a look at the Ceftriaxone insert."

"Why so many questions? I might have encountered a problematic patient here."

"It's not an allergy; I'd know if it were that. Just check if the Ceftriaxone insert mentions it causing gallstones."

Liu Zhuren didn't feel embarrassed about questioning Ji Xiang's claim; he focused his attention, holding the phone while waiting for the Pharmacy director's reply.

Ceftriaxone Sodium is not metabolized in the body; 60% is excreted by the urinary system, and 40% is excreted through the biliary tract and digestive tract.

If the gallbladder can form stones, then the urinary system can too, it is just extremely rare.

That was why he cautiously consulted the Pharmacy director first.

Soon, the phone rang. The Pharmacy director on the other end seemed very surprised, his voice rising by several decibels.

Liu Zhuren's orbicularis oculi muscles twitched a few times.

"I see. Thanks."

Hanging up the phone, Liu Zhuren looked at Ji Xiang in astonishment.

"Xiao Ji, you read drug inserts? And you can memorize them?"

Ji Xiang felt a bit ashamed; how could he possibly do that? It was all a cheat provided by the System NPC.

Seeing the strange expression on Ji Xiang's face, Liu Zhuren laughed and patted Ji Xiang on the shoulder.

"This is a good thing; I'm not the type to be jealous of talent. Xiao Ji, accompany me to perform an Endoscope in a moment."

"Understood, Zhuren."

Liu Zhuren no longer hesitated and turned back to find Xu Zhuren.

"Liu Zhuren, why have you come back? Did you leave something behind?" The Department of Nephrology's Xu Zhuren was startled.

"Xiao Ji reminded me, and I suddenly remembered something."

Liu Zhuren "translated" Ji Xiang's words again; although there were some gaps, Xu Zhuren from the Department of Nephrology could understand.

"Liu Zhuren, how come I've never heard of this?" Xu Zhuren questioned without hesitation.

"We're preparing to perform an Endoscope to take a look. Whether there's an issue or not, it will be clear at a glance."

"Perform an Endoscope?" Xu Zhuren was stunned; she didn't understand why an Endoscope was necessary.

"Xu Zhuren, you don't have a diagnosis and don't know what's going on, yet you don't believe me when I propose a possibility." Liu Zhuren immediately let his face fall. "If you don't want to, I'll go back. I'm exhausted after a day of surgeries; who wants to perform an emergency Endoscope?"

"Don't be like that!" Xu Zhuren immediately apologized with a smile. "Liu Zhuren, look at you. I just didn't understand, why are you getting angry? You're not usually like this; don't be so petty."

She prepared to check the data when sending the Patient to the Urology Department.

Having used Ceftriaxone for so many years, Director Xu, just like Liu Zhuren, also did not know that there was actually a possibility of it forming stones.

"Liu Zhuren, are there any other diagnostic methods?" Director Xu asked casually.

"Xiao Ji, you tell him," Liu Zhuren said proudly.

"The most reliable method to confirm Ceftriaxone stones is Infrared Spectroscopy, but our Second Affiliated Hospital has not yet launched this type of examination.

Diagnosis still needs to be combined with the Patient's medical history; when a Patient develops symptoms of Renal Colic after recent use of Ceftriaxone Sodium, while simultaneously presenting with sudden oliguria or anuria, one should first consider the possibility of acute post-renal kidney failure caused by Ceftriaxone stones."

"Although the probability of it occurring is not high, it does happen occasionally."

"..."

Upon hearing Ji Xiang's explanation, Director Xu felt completely unwell.

What Ji Xiang said was too professional, and he actually only half-understood it, which made Director Xu feel somewhat embarrassed.

Note: Ceftriaxone causing Gallstones was written about in the early days of the livestream room, but I did not know it could also cause Kidney lesions; I was very surprised when I flipped to the paper.

Source cited from—Journal of Clinical Urology, Issue 3, 2015.

(End of this chapter)