Chapter 2434: with translation of chapter title

"Surely not, do you know what chatting is?" Su Yun looked at Zheng Ren contemptuously.

"Zheng Ren Boss, what do you think the illness is?" Liang Boshi asked hurriedly.

"Just hearing you describe the symptoms, I haven't made a judgment yet." Zheng Ren said, "In a moment, bring the elderly lady over for me to take a look and do a simple physical examination."

"Hmm." Liang Boshi nodded.

"Chinese medicine talks about observation, listening, inquiry, and palpation; Western medicine talks about visual inspection, touch, percussion, and auscultation—these are all the most basic."

"Su Yun flipped through the lab report again, seeing that Liang Boshi had already done a very comprehensive examination on his mother; there really wasn't much to say."

"Apart from a minor issue with the ECG, everything else is normal, including brain waves; the spike waves are not obvious, so we cannot diagnose any mental illness, let alone epileptic seizures."

"Liang Boshi left the examination report, called out, and hurriedly went to pick up the elderly person. After he left, Su Yun asked, 'Boss, really no guesses?'"

"The only abnormality is the ECG." Zheng Ren took out the ECG, looked at it twice, and said, "PR and QT intervals prolonged, QRS wave widened, ST segment depressed, T wave widened—what do these changes make you think of?"

"Not only that, but some waveforms also show reduced voltage of the P wave and QRS complex. Looking at that waveform, one would definitely suspect hypomagnesemia, as standard as a panda wanting to eat bamboo." Su Yun said, picking up the ion test report, "But look, the blood magnesium is normal."

"Pandas are carnivorous animals..." Lin Yuan said softly.

"I still don't know?" Su Yun glared at her and said, "This, how do you explain it?"

"The following words were already being said to Zheng Ren."

"Serum magnesium being normal still cannot rule out a magnesium ion deficiency. Because serum magnesium is greatly affected by pH, protein, and other factors, a single ion test cannot explain any problem." Zheng Ren said.

"Su Yun shrugged, 'Your argument feels a bit forced.'"

"Let's look at the patient first; some cases of hypokalemia also present with the current symptoms."

"Don't talk nonsense, can you die?" Su Yun said, "Diagnosing hypokalemia, identifying the U wave is key. The general pattern is that as hypokalemia worsens, the T wave gradually diminishes, the U wave gradually rises, more leads show the U wave, the U wave equals or exceeds the T wave in the same lead, forming a camel-hump shape, and the T-U fusion cannot be distinguished, along with ST segment depression."

"Zheng Ren did not argue with Su Yun; he had too little data on hand. The argument before them was of the sort where nobody could convince anyone."

"Soon, Liang Boshi brought his mother over. Zheng Ren saw a medium-red System Panel, and the diagnosis was clear—hypomagnesemia."

"Auntie, do you feel any Uncomfortable?" Zheng Ren smiled and began taking the medical history.

"Although Big Pig Trotter gave the diagnosis, Zheng Ren still started from scratch, inquiring about every detail, so thorough that Lin Yuan felt it was a bit long-winded."

"The patient's own account of positive medical history only included episodic foot spasms; otherwise, nothing else."

"After Zheng Ren finished asking, he told Liang Boshi, 'Liangzi, take the auntie to do a magnesium load test.'"

"Liang Boshi stared for a moment and asked, 'Zheng Ren Boss, are you considering hypomagnesemia?'"

"Hmm, the spasms in the wrists and feet, the ECG changes, and during conversation your mother's eyes continually showed fine tremors, on examination the reflexes were slightly hyperactive, and there was neuromuscular tremor. All these point to hypomagnesemia; although the serum ion test is normal, we still cannot rule out this disease."

"Okay." Liang Boshi took his own elderly lady to get examined.

"Boss, now it looks quite like it." After finishing the physical exam, Su Yun also didn't object, he pondered, "But how did it come about?"

"Zheng Ren was also pondering this problem."

"Lin Yuan couldn't keep up with Zheng Ren Boss and Su Yun's train of thought; in her view, just a slightly abnormal ECG plus physical exam and history taking already gave a clear diagnosis—hypomagnesemia—which was already amazing enough."

"As for how it came about... I should first figure out how the diagnosis was made."

"First, consider excessive loss through the digestive tract." Su Yun held his phone, chatting with someone while multitasking, saying, "Since magnesium is absorbed in the small intestine and part of the colon, severe diarrhea, fatty diarrhea, malabsorption, enteritis, after major small intestine resection, etc., can lead to hypomagnesemia."

"Hmm, I just asked, and he hasn't had surgery. Normal people shouldn't have magnesium ion absorption problems; this can be ruled out." Zheng Ren sat in the chair, eyes narrowed, also pondering Liang Boshi's mother's condition.

"Second, excessive loss through the kidneys. Chronic pyelonephritis, tubular acidosis, acute renal failure with polyuria, or long-term use of loop diuretics, thiazides, and osmotic diuretics causing renal magnesium loss leading to hypomagnesemia."

"Just asked, and there isn't." Zheng Ren said, "We won't consider it a kidney problem."

"Losses have basically been considered; next is the possibility of insufficient supplementation or intake." Su Yun said, "I think this is the most important."

"But I just asked, and Liang Boshi also didn't find any dietary issues at home. Earlier I read a report saying vegans are prone to hypomagnesemia. The elderly lady eats meat, so she shouldn't."

"How about drinking water?"

"Generally there wouldn't be a problem." Zheng Ren shook his head, "Trace elements are minerals making up 0.01% of regional human body weight, mainly iron, zinc, copper, manganese, selenium, iodine, fluorine, cobalt, and magnesium—these nine. Since the body cannot synthesize them, they must be obtained from food."

"The human body can only absorb organic-state trace elements; it hardly absorbs inorganic-state trace elements, and the trace elements in water are mostly inorganic and in very low amounts."

"It has nothing to do with drinking water; people generally obtain trace elements from plants and animals."

"Boss, have you read this book? Healthy Water by United States Doctor Martin Fosks." Su Yun then changed the subject.

Zheng Ren shook his head.

"The book says the standard for healthy water is having a certain amount of hardness, ideally around 170mg/L, and a certain amount of dissolved total solids..."

"Never mind that, how does hypomagnesemia come about? This condition isn't common." Zheng Ren steered the topic back and continued asking.

"There must be something in the medical history not asked clearly, Boss, your clinical skills are poor. Xiao Linzi, I'll send you to ask; you need to get it clear." Su Yun laughed.

"Lin Yuan, being sensible, didn't move and didn't say much."

"The medical history that Zheng Ren Boss just inquired about was already quite complete; I don't know what else to add."

"Moreover, ask about the medical history again? The last patient with a patent foramen ovale accompanied by headaches is still fresh in my mind; Lin Yuan really doesn't want to go through that again."