Chapter 2271: 2194 Paraneoplastic Hypoglycemia

Seeing the patient, Zheng Ren was stunned for a moment.

The patient's system panel was redder than he had imagined; all the scenarios he had considered were wrong, and the patient's diagnosis was a common disease that rarely causes hypoglycemia.

"Boss Zheng, this is my client, named Du Liang." Lawyer Ge introduced.

"Hmm, let's go to the resuscitation room first." Zheng Ren brought Du Liang to the resuscitation room and began a routine interview.

Du Liang looked about fifty or older, his spirit listless, but his speech and manner were fine, basically normal.

His emotions were normal, memory and calculation normal, orientation intact, self-awareness normal—none of these were problematic.

"Have you felt anything uncomfortable lately?" Zheng Ren asked.

"Uncomfortable..." Du Liang hesitated, shook his head, but then nodded a second later, "Doctor, I often zone out, and when I come to, I find that a period of time has gone blank—I can't remember what happened at all."

"And after waking up, my lower back aches, sometimes my whole body hurts, especially my face."

Su Yun almost burst out laughing.

How could it not hurt? Slapping yourself like that over and over—if it didn't hurt, that would be freaky.

"Anything else uncomfortable? Your weight—" Zheng Ren hadn't finished when Du Liang's hand began to tremble, as if uncontrollable, and he started slapping his own face.

Zheng Ren really wanted to chop him in the carotid sinus with a hand knife, but the case of the deceased just now made him hesitate.

"Is this an attack? Manager Zhou, check his fingertip blood glucose." Su Yun said.

"What's your name?" Zheng Ren asked.

"I... I don't know... who am I?" Du Liang mumbled, "I'm the reincarnated Erlang Shen—I've remembered!"

This counts as slurred speech, Zheng Ren shook his head, saw the patient start to sweat, and immediately said, "After checking blood glucose, give 50 ml of 50% glucose intravenously."

Zhou Litao's side got busy.

Blood glucose was very low, 1.6 mmol/L. Less than three minutes after the intravenous glucose push, the patient gradually improved.

Lawyer Ge had seen this before and wasn't very surprised.

Compared to the patient, he cared more about how Boss Zheng had considered things. He had brought the person to room 912; even with sufficient evidence, he would still bear considerable responsibility.

"Let me think, Manager Zhou, come with me." Zheng Ren said.

"Okay."

Several people walked out of the resuscitation room; Zhou Litao instructed a nurse to watch the patient and make sure nothing else happened.

"Boss, let's do an abdominal CT; I suspect a pancreatic problem." Su Yun said directly.

This was the organ Zheng Ren had previously thought most likely to have problems, but the system panel's diagnosis was something else.

"Check the pancreas with ultrasound and CT." Zheng Ren then said, "Also do a chest CT."

Zhou Litao waited for Boss Zheng to continue giving orders, but the orders had already ended.

"Boss Zheng, anything else?"

"Hmm, just check those three." Zheng Ren said.

For admission exams, a chest X-ray or CT is routine; everyone thought Boss Zheng was just adding it as an afterthought and didn't pay much attention.

After writing the order and sending the patient for the exam, Zheng Ren sat in Zhou Litao's duty room waiting for Doctor Liang from the CT room to upload the images.

More than twenty minutes later, the pancreatic CT was uploaded.

Overall, there was nothing special; the pancreas was intact with no growths. Tumor-induced hypoglycemia usually comes from insulinomas, but the patient's pancreatic CT ruled that out.

Soon, the chest CT came back.

A 2×3.5 cm occupying lesion in the lower right lung was strikingly obvious. Its ground-glass appearance signaled that it was a malignant tumor.

Zheng Ren sighed; the big pig trotter was still reliable as ever. Although rare, checking a chest CT immediately yields a definitive diagnosis.

"Uh... is this paraneoplastic hypoglycemia?!!" Lin Yuan exclaimed first.

"Yeah, diagnose lung cancer with paraneoplastic hypoglycemia. Lin Yuan, call Lawyer Ge over." Zheng Ren said while carefully examining the patient's chest CT.

"Okay." Lin Yuan dashed out, afraid that if she weren't there, Boss Zheng might say something she'd get wrong.

Lawyer Ge came over in a quick trot.

"Lawyer Ge, consider the patient has lung cancer." Zheng Ren said without turning back.

"Lung cancer?!" Lawyer Ge froze.

"Huh." Zheng Ren said, "The earlier low blood sugar that caused the patient's delirium and abnormal behavior is considered paraneoplastic hypoglycemia; it's just a surface manifestation, not important."

"..." Lawyer Ge looked bewildered.

He just wanted to win a lawsuit; low blood sugar alone would have been enough to win, so why did a paraneoplastic hypoglycemia pop up?

The client really is ill, and it's lung cancer? But how does lung cancer trigger hypoglycemia?

Lung cancer, hypoglycemia—these two words simply wouldn't connect in Lawyer Ge's mind.

Not to mention Lawyer Ge, even Zhou Litao found it quite unfamiliar.

"Boss Zheng, please explain in detail." Lawyer Ge said, rubbing his hands.

"Paraneoplastic hypoglycemia usually occurs when the primary disease's clinical manifestations appear first or after diagnosing the primary disease, then hypoglycemia follows; clinically, cases where hypoglycemia appears first and lung cancer is discovered later are extremely rare."

"Uh... but hypoglycemia..." Lawyer Ge still didn't get it.

"Hypoglycemia syndrome is not an independent disease, but a syndrome of low blood glucose concentration caused by various factors."

"Causes of hypoglycemia include: malnutrition-related hypoglycemia; hepatic hypoglycemia; renal hypoglycemia; autoimmune disease–related hypoglycemia; reactive hypoglycemia; endocrine disease–related hypoglycemia; non-insulinoma hypoglycemia, etc." Zheng Ren's string of thoughts, with various professional terms, left Lawyer Ge dazed.

"Among them, hypoglycemia accompanying extrapancreatic tumors is rarer; other tumor types related to hypoglycemia are mesenchymal tumors, accounting for 64%, of which 50% occur in the abdominal cavity, and hepatocellular carcinoma accounts for 21%. This patient's situation is even rarer—it's lung cancer." Zheng Ren said.

"Why would this happen?" Lawyer Ge still didn't understand.

"Lin Yuan, explain to Lawyer Ge why." Su Yun glanced at Lin Yuan and instructed.

"First, consider that the patient's symptoms are related to the tumor secreting insulin-like factor 2; IGF-2 binds to its receptor and activates it, increasing peripheral tissue glucose uptake, decreasing hepatic glycogen output, causing blood glucose to drop, producing hypoglycemic symptoms."

Su Yun watched Lin Yuan recite one-two-three, thinking he was a bit like the boss—utterly bookish.

"Furthermore, the tumor's own increased glucose utilization can also cause..." Lin Yuan didn't notice Su Yun's expression, but continued to elaborate on the situation.