After taking antibiotics, Mr. Wang thought his body would recover smoothly. Unexpectedly, within a full month, Mr. Wang went to the hospital many times due to diarrhea and lost more than ten kilograms in a short period of time.

Text: Xinyi

55-year-old Mr. Wang has been suffering from chronic bronchitis for 8 years and has chronic cardiac insufficiency due to coronary heart disease 3 years ago. One month ago, he went to the hospital for diarrhea due to eating an expired piece of mung bean cake. At that time, his blood routine and stool examination showed infection. The doctor prescribed levofloxacin for oral administration at home.

After taking antibiotics, Mr. Wang thought his body would recover smoothly. Unexpectedly, within a full month, Mr. Wang went to the hospital many times due to diarrhea and lost more than ten kilograms in a short period of time. His case, in which conventional treatments were ineffective, aroused great concern from gastrointestinal clinic doctors.

Under careful questioning by the outpatient doctor, Mr. Wang recalled that he had been taking ceftriaxone for several days due to lung infection in mid-July. At the end of July, when I went to the intestinal clinic for the first time due to diarrhea, I received 3 days of oral levofloxacin treatment. After taking the medicine, the frequency of diarrhea and abdominal pain improved.

In order to further consolidate the treatment, Mr. Wang went to a nearby hospital to take Levofloxacin for a week. This continuous use of antibiotics not only failed to cure Mr. Wang's diarrhea, but the symptoms continued, which is indeed puzzling.

The doctor conducted further tests on Mr. Wang’s stool and found that the occult blood test in the stool was actually positive, indicating that there was trace bleeding in the digestive tract. In order to find out the bleeding site, the hospital arranged a gastroenteroscopy, but the result was that the gastrointestinal tract was found in the stomach and ten No obvious abnormalities were found in the duodenum, only congestion was observed in the colon, and no polyps or suspicious tumors were found.

Are there any possible causes that have not been considered? The doctor recalled Mr. Wang's self-reported medical history, which showed that he had used large doses of antibiotics for a long time, which could easily cause imbalance in the human intestinal flora. He was likely to have antibiotic-related diarrhea.

In clinical practice, because the normal flora is greatly suppressed, "the tiger is not at home, the monkey is the king" situation will occur. 20% of patients will suffer from a type of anaerobic bacteria in the intestines—— An infection caused by overgrowth of Clostridium difficile.

Subsequently, the doctor cultured Mr. Wang’s stool. Sure enough, after testing Mr. Wang’s stool specimen for Clostridium difficile and its toxins, the gastroenterologist’s suspicion was confirmed. The specimen contained Clostridium difficile and its toxins. Both A and B are positive, indicating Clostridium difficile infection!

At this time, Mr. Wang's diarrhea had not improved. While he was waiting for an inpatient bed in the emergency observation area, he suddenly felt a burst of suffocation and palpitations in his chest. The doctor quickly gave him an electrocardiogram and prompted the room. Sexual tachycardia , the doctor immediately arranged further tests, and soon the test report came out, indicating hypokalemia.

While the doctor was still looking at other results, he suddenly heard the nurse shouting: Doctor, come here quickly! I saw that Mr. Wang lost consciousness and his face was purple. The ECG monitoring showed ventricular fibrillation, which means that the contraction function of the heart cannot proceed normally and blood circulation cannot be maintained. This is a life-threatening signal!

While directing the rescue, the doctor asked Mr. Wang’s family if there was anything they had not told him. According to the family’s memories, Mr. Wang had been taking anti-heart failure drugs: digoxin since he suffered from chronic cardiac insufficiency three years ago. Since the diarrhea, he has not stopped taking it. The cardiovascular doctor said that the blood concentration of digoxin should be checked regularly, but he did not check it because of the diarrhea.

After hearing this, the doctor immediately understood the cause of Mr. Wang’s ventricular fibrillation attack: According to the drug instructions for digoxin, digoxin should be used with caution when potassium is low, because low potassium can easily cause digoxin drug poisoning, which can lead to The occurrence of ventricular arrhythmias , the most serious of which is ventricular fibrillation.

Mr. Wang has had diarrhea for almost a month. Diarrhea can cause the loss of a large amount of intestinal fluid that is rich in potassium ions. In addition, coupled with a poor appetite, he failed to replenish potassium ions in time, resulting in low potassium in the body, and He also failed to adjust the dosage of digoxin in time, resulting in digoxin poisoning and ultimately the onset of ventricular fibrillation.

In the end, after the emergency doctors’ full rescue efforts, Mr. Wang’s heart rate and breathing were restored. However, due to long-term hypoxia, he remained in a coma. A few days later, his family reluctantly signed for discharge and took him back to his hometown.

It may seem like a simple diarrhea, but it is full of dangers due to the patient's special medical history and medication. So what other diseases that we rarely pay attention to usually have gastrointestinal symptoms such as nausea, vomiting and diarrhea as the main manifestation or even the only symptom?

I will summarize it for you today as follows:

1, Henoch-Schonlein Purpura

When you think of allergies, you may first think of rashes, which are spread all over the body, are itchy, and take a while to subside.

Henoch-Schonlein purpura is different from ordinary allergies. It is a vascular allergic vascular disease. A simple understanding is that even the blood vessels are allergic, causing the blood in the blood vessels to leak to the outside, resulting in a series of symptoms. In addition to bleeding spots appear on the skin, which can also cause damage to other parts of the body. Common ones include abdominal type Henoch-Schonlein purpura and renal-type Henoch-Schonlein purpura.

Among them, abdominal type Henoch-Schonlein purpura is a disease of the blood vessels in the abdominal cavity, causing acute diarrhea . It is not uncommon. In a few cases, there are no bleeding spots on the skin in the early stage of the disease or occasionally during the entire course of the disease, and they only show acute enteritis. symptoms may lead to misdiagnosis. In severe cases, blood may accumulate in the intestinal lumen, which may be life-threatening.

2, allergic gastrointestinal disease

It has some connection with what we often call food allergy , but it is not exactly the same. It refers to the acute gastrointestinal symptoms caused by eating food that can be tolerated by ordinary people. It can be manifested as vomiting, abdominal pain and diarrhea, and is often accompanied by urticaria , migraine -like headache, and edema. .

There are many foods that can cause allergic gastrointestinal diseases. Common ones include shrimps, crabs, marine fish, various dairy products, eggs, etc. The basic feature is that they are mainly heterogeneous proteins.

3, Uremia

Uremia generally refers to the end-stage state of various kidney diseases. Since the kidney function is almost completely lost, the body enters an anuric state and cannot excrete various toxic and harmful substances in the body in a timely manner, causing accumulation.

These accumulated toxins can irritate the gastrointestinal mucosa and produce uremic enteritis. Nausea, vomiting, and diarrhea can even be the first symptoms of uremia. In clinical practice, patients with the above symptoms are not uncommon. It is not uncommon for patients to have blood creatinine of 3 or 4000. .

In addition, 60-70% of patients may suffer from intestinal mucosal bleeding, ulcers or even perforation.

4, hyperthyroidism or even thyroid storm

When hyperthyroidism is stimulated by excessive thyroid hormone , all the organs in the body operate faster, and the peristalsis and secretion functions of the intestines are no exception. Under the urging of "moving forward", food could have traveled an 8-hour journey, but now it takes 4 hours, and diarrhea is unavoidable.

In addition, there is another life-threatening disease called thyroid crisis. It usually occurs when hyperthyroidism is not controlled in time, or when there is infection or insufficient preparation before thyroid surgery. The fever can reach as high as 40°C, accompanied by cardiac arrest. Rapid , profuse sweating, abdominal pain, diarrhea, and even hallucinations and coma.

5, acute ulcerative colitis

Ulcerative colitis is an autoimmune disease . The lesions are mainly concentrated in the lower half of what we call the large intestine: sigmoid colon and rectum . The simple understanding is Because the mucosa of this section of the large intestine has been inflamed for a long time, there is no good way to treat it but to control it. The result of inflammation of the large intestinal mucosa is abdominal pain and diarrhea.

If it is an acute attack, diarrhea can occur 10-30 times a day. In addition to watery stools, there may also be watery and bloody stools.

The patient is in excruciating pain and restless.Many celebrities suffer from this disease. The former prime minister of our neighboring country, Japan, Shinzo Abe , suffered from this disease. It is said that his term as prime minister was interrupted due to an acute attack and he was unable to see things. This shows that the power of this disease cannot be tolerated. Being underestimated is enough for a country's leader to retire and cultivate himself.

Finally, I would like to remind everyone that diarrhea may seem common, but in different population backgrounds, different past medical histories, and different medication situations, the possible causes behind it may be complicated, and professional doctors are required to judge and treat it. When we usually see a doctor, we should truthfully inform the doctor of our condition so that the doctor can make a more accurate judgment.

Reference:

1. Abdominal Henoch-Schonlein purpura[J]. Health Management, 2016(02):91-92.

2. Zhang Shunhong. Issues that should be paid attention to when using digitalis in the treatment of chronic heart failure[J]. Longevity, 2020(02):123.

3. Zhu Rongsheng. Hanging water brings out difficult bacteria[J]. Health Expo, 2019(12):38-39.

4. "Differential Diagnostics of Internal Medicine Diseases" (People's Health Publishing House Society, fifth edition)

5. "Is the ulcerative colitis that prompted Shinzo Abe to resign an "incurable disease"? The truth is here". Medical Federation Media, 2020-09-01