The Enhanced Doctor-Chapter 503 Serious patient’s family member

"Banxia, how sure are you?" Wei Yuan asked.

Liu Banxia shook his head. "I don’t know. Did the patient mention any symptoms of muscle pain?"

Wei Yuan also shook his head. "The patient didn’t say. He had just regained consciousness from a coma, and speaking was very difficult for him."

"It was only after you mentioned Grandpa Cao that I remembered. The reason I diagnosed him back then was because I smelled the scent of rotten apples on him," Liu Banxia said after a moment’s thought.

"And your mentioning it made me realize: when the patient was wheeled past us, I don’t think I smelled it. Try to recall, did you smell it when you first saw the patient?"

Wei Yuan thought carefully and shook his head. "I was wearing a mask, so I didn’t notice it at the time. If it’s actually confirmed as rhabdomyolysis, I owe you a pig’s foot."

Liu Banxia waved his hand. "Let’s wait for the lab results. These two diseases have many similarities, but they also have slight differences."

The first results to come back were from the previous blood test: a pH value of 7.2. The normal human body pH value is between 7.35 and 7.45; this was already a sign of acidosis.

The blood ketone level was also a bit high, and kidney function was already affected. Based on the current test results, it still leaned towards ketoacidosis.

However, this condition and rhabdomyolysis present similarly in current tests. The only differences would be in the urine ketone levels and the creatine kinase and myoglobin indices. These two are the standards for differentiating between the diseases.

Still, Liu Banxia’s point made sense; it wasn’t easy to confirm the smell of rotten apples as the patient was hurried past.

It was unclear whether the patient had symptoms of muscle pain. Even if he did, it wasn’t certain whether this pain was the patient’s misperception or caused by the coma.

So now they had to look at the indices; this was the scientific basis, not something one could just guess and call a day.

In his heart, Liu Banxia was leaning towards rhabdomyolysis.

After his body had been strengthened, his overall senses had also improved. He was quite certain that he hadn’t smelled the scent of rotten apples when the patient passed by earlier.

However, this didn’t rule out the possibility of ketoacidosis. In the early stages of the disease, this smell might not have been present, or it might have been too faint and masked by clothing.

The head CT scan was completed and showed no problems. However, the latest test results weren’t out yet, so they couldn’t proceed with further treatment for the patient.

"Doctor, shouldn’t you give him an IV or insulin?" The patient’s son came over to ask.

"We’re still waiting for the final test result to see if it’s ketoacidosis or rhabdomyolysis," Wei Yuan said.

The patient’s son frowned. "Isn’t rhabdomyolysis something that only happens after eating crayfish or a lot of strenuous exercise? My father just eats regular meals at home. These past few days, we’ve been preparing for the New Year, and he’s only been going for a walk downstairs in the morning."

"Actually, there are many potential causes: excessive exercise, muscle crush injuries, metabolic disorders, extreme body temperatures, drugs, toxins, autoimmune diseases, and so on. Any of these could lead to it," Wei Yuan said.

"We’re waiting for the last test result now. It should be out in a few more minutes. If it’s rhabdomyolysis, we need to send him to the ICU first. If it’s ketoacidosis, we can manage it by admitting him to the internal medicine ward."

"Hmph, are you just trying to make more money?" the patient’s son suddenly interjected.

Wei Yuan shook his head calmly. "How could we overcharge you without a clear result? If it really is rhabdomyolysis, sending him to the ICU is to save his life."

"Then why did you initially say it was poisoning caused by diabetes?" the patient’s son retorted.

"Because these two conditions are very similar, and your father’s blood sugar is a bit high. However, during the physical examination, your father couldn’t give us an accurate description, so we ordered additional tests," Wei Yuan said.

"Your father still hasn’t urinated, so it’s highly likely there’s a problem with his kidneys. And whether it’s ketoacidosis or rhabdomyolysis, both will cause damage to kidney function."

"Without clear indications, we wouldn’t just send a patient to the ICU. I can even tell you that many patients here want to get into the ICU but can’t."

"Anyway, don’t think you can fool me. I’ll check the medical records later," the patient’s son said.

Wei Yuan nodded. "That’s perfectly fine."

Nothing more needed to be said; it was normal for the patient’s family to have such thoughts.

After all, everyone’s initial judgment had been ketoacidosis. If it turned out to be rhabdomyolysis, then blood dialysis would be necessary, followed by correcting the body’s electrolyte balance.

After the patient’s son left, Liu Banxia said with a wry smile, "I hope my big mouth doesn’t cause a medical dispute."

Wei Yuan gave him a wry smile. "Now I’m personally leaning towards it being rhabdomyolysis. It seemed like when I was doing the muscle weakness grade test, the patient frowned."

"I didn’t pay too much attention at the time; I just thought he had recently awakened and was a bit uncomfortable. It’s possible the test actually worsened his muscle pain."

"Let’s wait; the results should be out soon. Xu Yinuo, contact the ICU in advance. If it’s confirmed, treatment can be initiated immediately," Liu Banxia instructed.

Xu Yinuo nodded, quickly took out her phone, and contacted the ICU.

After a short wait, the latest test results came back, showing exceptionally high levels of creatine kinase and myoglobin.

DING! Consultation task completed.

Experience gained: 300 points. Diagnostic proficiency: 200 points.

"Liu Yiqing, inform the family. Their father has rhabdomyolysis and needs to be transferred to the ICU," Wei Yuan said.

Wei Yuan’s intention was that having someone else deliver the news might make it easier for the family to accept. However, he had truly misjudged; the patient’s son didn’t trust Liu Yiqing.

"Doctor, on what basis are you judging that my father needs to go to the ICU? And how did he get rhabdomyolysis?" the patient’s son asked, walking over.

"The diagnosis is based on the latest test results. His creatine kinase and myoglobin levels are extremely high. Combined with the patient’s current acidosis and renal dysfunction, we can confirm it’s rhabdomyolysis," Wei Yuan explained.

"However, the exact cause is still unclear at this point. As I just mentioned, there could be various causes."

"It could be due to the patient’s own metabolic disorder or an autoimmune issue, or it might have been caused by those pills he was taking."

"So, are you saying you misdiagnosed him initially?" the patient’s son pressed.

Just as Wei Yuan was about to speak, Liu Banxia waved his hand. "Right now, do you want to pursue this, or do you want to save your father’s life?"

"Fine. You all just wait. This isn’t over. I will definitely hold you accountable," the patient’s son said.

"Certainly. You can even go to the Health Bureau. See if we followed standard procedure or misdiagnosed your father," Liu Banxia also said seriously.

"However, five minutes have passed since we informed you. If your delay endangers the patient’s life, that will have nothing to do with us."

"This will also be recorded in the patient’s entire resuscitation process, because this is an emergency patient, and every step we take must be documented."

The patient’s son glanced at Liu Banxia, said nothing more, and followed the nurse, pushing the patient towards the ICU.

"Brother Wei, don’t take it to heart. We encounter all kinds of patients’ families. Actually, his meticulous nature is quite good; it’s just not being applied in the right place, and he can’t distinguish what’s important right now," Liu Banxia comforted him.

"I’m not taking it to heart. I just feel that in many people’s minds, the hospital’s reputation seems to be a negative value already, right? Otherwise, he wouldn’t think that way," Wei Yuan said.

"There’s nothing we can do about it. They choose to hear what they want to hear and ignore what they don’t. What can you do? I don’t believe any doctor in any hospital would dare to give a definitive diagnosis before the test results are out," Liu Banxia said.

"Even the conditions we mention are merely possibilities. No one would state them decisively; not even Qing Kewa would do that."

Everyone chuckled; this was indeed the case.

When doctors receive patients, the words they speak carry responsibility. The final diagnosis of any illness requires relevant data for support.

This is a way to mitigate risk. Even if, during a consultation, a doctor explains some conditions due to a patient’s inquiry, those explanations will definitely be preceded by words like ’possibly,’ ’likely,’ or ’probably.’

This could also be considered a form of self-protection.

Take today’s patient, for example. If Wei Yuan had decisively said it was definitely ketoacidosis, and it happened to be recorded by the meticulous patient’s son,

Then that would be it. Even if you followed standard procedures, if something happened to the patient, the family could still file a complaint against you.

"Sigh, I was too quick to assume," Wei Yuan sighed.

"Anyone would have done the same. Even if I were the one seeing the patient, I would have handled it the same way," Liu Banxia said.

"We really have to thank Grandpa Cao. If you hadn’t brought him up, I wouldn’t have remembered the rotten apple smell. This patient should be fine; it was caught in time, and a few days of adjustment should do it."

"Last time when I was helping with a pediatric consultation, I also jumped to conclusions. Fortunately, we eventually found the true cause of the illness and resolved the issue."

"Nowadays, many conditions have overlapping external manifestations. Any doctor receiving this patient would first suspect ketoacidosis."

"Only after diuresis, catheterization, and a urine test showed normal urine ketones would they proceed with other tests. We saved at least half an hour, which is already quite successful."

Wei Yuan patted his shoulder. "I owe you a pig’s foot. I’m going to eat first. Can’t say when I’ll be able to repay you."

The interns were all amused, but in their hearts, they reminded themselves that they had to be even more meticulous during future consultations.

At the very least, for patients suspected of ketoacidosis, one must use their nose to check for the smell.