"Of course not. Do you know what it means to chat?" Su Yun looked at Zheng Ren with disdain.
"Boss Zheng, what kind of illness do you think it is?" Dr. Liang asked quickly.
"I can't make a judgment just by listening to your symptoms," Zheng Ren said. "Bring the old lady to me later and I'll do a simple physical examination."
"Okay." Dr. Liang nodded.
Chinese medicine emphasized observation, listening, questioning, and palpation while Western medicine emphasized sight, touch, and hearing. These were the most basic.
Su Yun flipped through the test results again. Seeing that Dr. Liang had done a comprehensive examination on his mother, there was nothing more to say.
Other than a small problem with the electrocardiogram, everything else was normal, including the brain. The spikes were not obvious and could not diagnose any mental illness, let alone epileptic seizures.
Dr. Liang left the examination report, called out to Su Yun, and hurried to pick up the old lady. After he left, Su Yun asked, "Boss, are there really no guesses?"
"The only abnormality is the electrocardiogram." Zheng Ren took out the electrocardiogram and looked at it again. "The PR and QT intervals are lengthened, the QRS wave is widened, the ST segment is decreased, and the T wave is widened. What do you think of these changes?"
"Not only that, but a few waveforms can also be seen that the voltage of the P-wave and QRS wave groups is decreased. Looking at the waveforms, it's definitely hypomagnesemia. It's like a panda eating bamboo, "Su Yun said as he picked up the ion test report." But look, the blood magnesium is normal. "
"Pandas are carnivores …" Lin Yuan said softly.
"You think I don't know?" Su Yun glared at her and said, "How do you explain this?"
The rest of the sentence was already directed at Zheng Ren.
"The serum magnesium is normal, but it still can't be determined that there is no magnesium deficiency. Because serum magnesium is greatly affected by changes in pH, protein, and other factors, a simple ion test can't explain anything, "Zheng Ren said.
Su Yun shrugged his shoulders. "What you're saying is a little too much."
"Look at the patient first. Some people with hypokalemia will also have the current symptoms."
"Can you die if you don't talk nonsense?" Su Yun said. "Identifying the U wave is the key to diagnosing hypokalemia. The general rule is that with the gradual aggravation of hypokalemia, T wave will gradually decrease, U wave will increase, and the number of leads with U wave will increase. The U wave will be equal to or higher than the T wave of the same lead, forming a camel shape. T-U fusion cannot be distinguished from ST-segment decline. "
Zheng Ren did not argue with Su Yun. He had too little information on hand. The argument in front of him belonged to a situation where no one could convince the other.
Soon, Professor Liang brought his mother over. Zheng Ren saw the medium red System panel. The diagnosis was clear — hypomagnesemia.
"Auntie, are you feeling unwell?" Zheng Ren asked with a smile.
Although he had the System's diagnosis, Zheng Ren still asked from the beginning. He was so detailed that Lin Yuan felt that he was a little long-winded.
The patient's positive medical history was only paroxysmal foot spasms and nothing else.
After Zheng Ren asked, he said to Dr. Liang, "Liang Zi, take Auntie to do a magnesium load test."
Dr. Liang was stunned and asked, "Boss Zheng, are you considering hypomagnesemia?"
"Yes, the spasms of the wrist and foot, the changes in the electrocardiogram, and the slight tremors in your mother's eyes during the conversation. During the physical examination, there was a slight excitement in the reflex and neuromuscular tremors. "These are all considered to be hypomagnesemia. Although the serum ion test is normal, this disease cannot be ruled out."
"Okay." Dr. Liang brought his old lady to do the examination.
"Boss, it looks like it now." After the physical examination, Su Yun did not object. He pondered and said, "But how did it come about?"
Zheng Ren was also thinking about this problem.
Lin Yuan did not keep up with Boss Zheng and Su Yun's pace of thinking. In her opinion, only a slightly abnormal electrocardiogram, physical examination, and medical history could give a clear diagnosis — hypomagnesemia. It was already amazing enough.
As for how it came about … It was better to figure out how to diagnose it first.
"First, consider excessive loss of the digestive tract." Su Yun held his phone in his hand and chatted with someone while multitasking. "Because magnesium is absorbed in the small intestine and part of the colon, when severe diarrhea, steatorrhea, malabsorption, intestinal fistula, large part of the small intestine resection, etc., it can lead to hypomagnesemia."
"Yes, I just asked. He hasn't done surgery. Normal people shouldn't have problems with magnesium absorption. This can be ruled out. "Zheng Ren sat on the chair and narrowed his eyes. He was also thinking about Dr. Liang's mother's condition.
"Second, too much kidney loss. Chronic pyelonephritis, renal tubular acidosis, acute renal failure, polyuria, or long-term use of loop diuretics, thiazides, and osmotic diuresis will cause the kidney to lose magnesium and cause hypomagnesemia. "
"I just asked. There's no," Zheng Ren said. "Don't consider it a kidney problem."
"The loss has basically been considered. Next is the possibility of insufficient replenishment and insufficient intake," Su Yun said. "I think this is the most important point."
"But I just asked, and Dr. Liang didn't find any problems with the family's diet. A while ago, I read a report saying that vegans are prone to hypomagnesemia. The old lady eats meat, so it shouldn't happen. "
"What about drinking water?"
"Usually, there won't be any problems." Zheng Ren shook his head. "Trace elements are minerals that make up 0.01% of the body weight in the region. There are mainly nine types: iron, zinc, copper, manganese, selenium, iodine, fluorine, cobalt, and magnesium. These elements can't be synthesized by the human body and can only be obtained from food. "
"The human body can only absorb trace elements in the organic state and can hardly absorb inorganic trace elements. Most of the trace elements in water are inorganic, and the amount is very small."
"It has nothing to do with drinking water. People usually get trace elements from plants and animals."
"Boss, have you read a book? 'Healthy Water' by Dr. Martin Fox in the United States. "Su Yun changed the topic again.
Zheng Ren shook his head.
"The book says that the standard for healthy water is to have a certain amount of hardness (the ideal value is about 170 mg/L) and a certain amount of total solubility …"
"Let's not talk about this. How did hypomagnesemia come about? This disease is rare. "Zheng Ren pulled the topic back and continued to ask.
"There must be a medical history that wasn't asked clearly. Boss, your clinical skills are very poor. Little Lin, I'll send you to ask. You have to understand, "Su Yun said with a smile.
Lin Yuan tactfully did not move or say much.
The medical history that Boss Zheng had asked was very complete. He did not know what to add.
Moreover, to ask about the medical history again? The last patient with patent foramen ovale and a migraine was still vivid in his mind. Lin Yuan did not want to experience it again.
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