Chapter 447: 439 An Elderly Patient with Good Rapport

A stretcher pushed a middle-aged male patient, like a wild dog that had shaken off stiffness, rushing straight to the emergency resuscitation room.

Zheng Ren glanced at the system panel in the upper right of his field of view.

What a strange diagnosis.

Brain trauma, ketoacidosis!

To Zheng Ren, of these two diagnoses, brain trauma is utterly unimportant.

Not even a subarachnoid hemorrhage—would Zheng Ren care?

Brain trauma is similar to the concussion diagnosed ten years ago, except that concussion is no longer a diagnosis now.

The patient had no organic lesion; merely due to head impact, transient symptoms of dizziness, headache, nausea, vomiting, etc., are collectively called brain trauma.

Because there is no organic lesion, it has become the ideal condition for feigning injury in fights or traffic accidents.

None of that matters; what is life-threatening is ketoacidosis.

Pathophysiologically, ketone bodies are intermediate metabolites of fat breakdown into fatty acids in the liver.

Under normal conditions, the body produces a small amount of ketone bodies, which are transported by blood to tissues such as heart, kidneys, and skeletal muscle to be used as energy; blood ketone concentration is low, generally not exceeding 1.0 mg/dL, and ketones are undetectable in urine.

In severe diabetic patients, ketones can be detected in urine; if even more severe, excess ketones accumulate in the blood, making it acidic and causing acidosis, termed ketoacidosis.

Zheng Ren watched the nurse busily attach an ECG monitor to the patient, establish an intravenous line, and await the doctor's next instructions.

He leaned close to the patient and smelled a rotten apple odor; Zheng Ren now knew it must be ketoacidosis.

"Check his blood sugar." Zheng Ren said: "Call endocrinology right away and have the inpatient chief come for a consultation."

The nurse was somewhat surprised; the patient's head was bandaged, an obvious head injury—why would Chief Zheng request an endocrinology consultation?

However, the strict hierarchy between hospital superiors and subordinates prevented them from voicing opinions during resuscitation; they chose to obey instead.

"Patient's family!" Zheng Ren shouted.

An eighteen- or nineteen-year-old youth accompanied the patient in the ambulance, rushing to Zheng Ren's side: "Doctor, is there danger?"

At the same time, hurried footsteps sounded down the hallway.

Normally, an ambulance allows one family member aboard to help care for the patient. Of course, rules vary by place; in Hai Cheng it is like this.

Other family members may take a taxi or drive themselves to follow the ambulance to the hospital.

Zheng Ren saw it was a young person and was somewhat displeased.

The adults of this family are really carefree. He estimated the patient's age at about sixty-plus; this child could be his grandson or grandnephew.

What are the adults doing, letting a teenager ride along in the ambulance?

"Where are your parents?" Zheng Ren asked.

"……" The youth stared for a moment, then said: "They're at work."

"Are any other adults coming?" Zheng Ren asked.

"Aunt Zhao and Uncle Li are coming along."

This makes things rather difficult to handle; Zheng Ren finds it a bit troublesome.

The patient's life-threatening diagnosis is ketoacidosis, which could kill him at any moment. Yet the immediate family who run the household are not present……

"Well then, you'll have to do. What is your relation to the patient?"

"I am his neighbor."

"……" Zheng Ren was dumbfounded—what kind of messed-up relation is this?

"Chief Zheng, the patient's fingertip blood glucose is 54.2 mmol/L." The nurse said admiringly.

Such an extreme glucose level is rarely seen even in the emergency department. Perhaps endocrinology encounters it more often?

This also indirectly confirms the severity of the patient's condition.

Zheng Ren does not know how to manage ketoacidosis. Not that he's completely incapable, but at least he lacks expertise.

"10 units of insulin subcutaneously, 500 mL saline. Draw blood for gas analysis and electrolytes." Zheng Ren said immediately.

Low-dose insulin corrects hyperglycemia; together with fluid replacement, it corrects fluid loss and ionic imbalance—this is the initial focus of treatment.

That's all Zheng Ren can do.

The endocrinology department is not far from the emergency building; in a few minutes, we might not even be able to draw arterial blood for gas analysis, so we'll have to push the patient to endocrinology for specialized treatment.

At that moment, a middle-aged man and woman rushed in, panting.

"Doctor, how is Uncle Wang?"

Zheng Ren glanced at them and asked: "It's very dangerous—have the patient's immediate family been notified?"

"He has no immediate family; he lives alone. We're all neighbors," the man said.

"Um……"

Zheng Ren was in a dilemma.

However, this man seems to have good rapport. Nowadays neighborly relations are often cold; if they were a bit worse, someone could die at home and rot before being discovered.

"The patient's blood sugar is especially high; the diagnosis is ketoacidosis, very dangerous—he will need to go to endocrinology for inpatient treatment shortly." Zheng Ren earnestly examined the three people who had brought the patient, hoping to discern something from their expressions.

"Whether he can be saved is uncertain." Zheng Ren said: "Soon, who will go pay the hospitalization fee?"

"Doctor, do your best. Don't worry about the hospitalization fee—I'll go pay it shortly," the man said.

"Older Brother Li, your family isn't well-off either, and your child is still young—let me handle it," the woman said.

Zheng Ren was somewhat surprised.

In the hospital, in the emergency department, having grown accustomed to cold human relations, it is truly rare to see someone vying to pay the hospitalization fee for such a widowed, orphaned, lonely elder.

The youth who arrived first said firmly: "Uncle, Aunt, don't argue—I'll pay first. While in the ambulance, I called my dad; he's on his way back and told me to pay the money first. I still have my New Year's money, so it's fine."

While they were arguing, a deputy chief from endocrinology rushed over.

Feng Qing, over forty, short in stature, simple and honest in appearance, speaks with a slight stutter.

Zheng Ren knows Feng Qing, because in general surgery, when assessing elderly patients for surgery preoperatively, about half require an endocrinology consultation.

Outpatient consultations are handled by Deputy Chief Feng Qing; emergency consultations are handled by the Inpatient Chief.

I don't know how he ended up coming here today.

"Director Feng, the patient's blood sugar is over 50, consider ketoacidosis." Zheng Ren ignored the quarrel among the neighbors and turned to brief Director Feng: "I've already given a low dose of subcutaneous insulin, and checked blood gases and electrolytes."

"Okay." Feng Qing didn't speak much either, because he has a stutter, so he usually expresses himself with just one or two words.

"Admit him to the hospital?" Zheng Ren respectfully sought Feng Qing's opinion.

"Okay." Feng Qing said while beginning the physical exam.

The patient showed problems with light reflexes, indicating the condition had become quite serious.

"Should we do the head CT now or later?" Zheng Ren asked.

"Con… consider it's not an external head…… head trauma issue, it should be due to ketoacidosis…… admit him." Feng Qing said bluntly.