Li Diadia has a very complex history of disease. With years of clinical experience, Professor Yang Yu sensitively realized that these multi-system diseases should have a core cause, and the cause must be found in order to solve this series of problems and catch the "culprit" behind it. The blood potassium content of
continues to be low. Multiple examinations have identified the cause of
. After the patient was admitted to the hospital, Director Yang Yu and Professor Li Xiang of found that the patient's blood potassium content was low and he had renal insufficiency. The patient's heart failure improved. He took 6 grams of potassium orally + 6 grams of intravenous veins every day. For three consecutive days, the patient's blood potassium was still lower than 2.35. Considering that the patient was 80 years old, he was at risk of sudden death of at any time.
Director Yang Yu analyzed that after using drugs to supplement potassium, the patient's blood potassium content is still very low, and it is necessary to continue to investigate the cause in depth. Based on the patient's various examinations, three possible points are proposed:
1. Nephrogenic cause: renal tubular acidosis? Because the patient has elevated blood chlorine, hypokalemia , neurodeafness and kidney stones, further diagnosis is needed;
2, primary aldosterone : There are symptoms of hypokalemia and hypertension . The blood pressure of this patient is in the normal range and needs further investigation;
3, metastatic hypokalemia: hyperthyroidism and excessive blood sugar can all be caused. The patient's blood sugar is normal and the thyroid function is normal, so it is not considered.
was hospitalized on the third day. The results of the examination showed that hyperchloremia, metabolic acidosis, and respiratory alkalosis compensation period were found. Combined with the patient's kidneys, bone pain, , bone mass reduction, osteoporosis, urinary PH7.0, greater than 5.5, it was pointed out that it can be confirmed as renal tubular acidosis ɪ type (link for the diagnosis of renal tubular acidosis with standard treatment).
The disease causes a wide range of pathogenesis. Most of the primary are autosomal recessive inherited diseases. Secondary common are: autoimmune diseases such as Sjogren's syndrome , systemic lupus erythematosus , rheumatoid arthritis, vasculitis , etc.; diseases related to renal calcification: hyperparathyroidism , hyperthyroidism, vitamin D poisoning, etc.; drugs or toxic nephropathy; or chronic pyelonephritis , obstructive nephropathy , kidney transplantation and other kidney diseases.
If it is renal tubular acidosis, the various strange symptoms that have tortured Li Diadia for more than 40 years have reasonable explanations.
Li Diadia is atypical renal tubular acidosis. There are no symptoms of acidosis in daily life, and it only occurs from time to time, so it is very difficult to diagnose.
Combined with Li Diadia's condition, there may be two causes of the disease:
1: Primary: Autosomal recessive genetic disease, can be identified through gene detection. In order to prevent the inheritance of offspring, Li Diadia's son also needs to undergo genetic testing to prevent the same disease;
2. Secondary: Because the patient has kidney stones and hydronephrosis , renal tubular acidosis may be caused by kidney disease.
Director Yang Yu and Professor Li Xiang of the Adult Comprehensive Internal Medicine quickly convened general studies and formulated a diagnosis and treatment plan: treatment is mainly about eliminating the cause, treating the primary disease, correcting acidosis, and supplementing potassium salt .
potassium citrate is recommended, and it is best not to use potassium chloride to avoid aggravating hyperchloremia.
Pain Department and Urology Consultation: Treat Li Diadia's multiple system diseases such as osteoporosis, kidney stones, hydronephrosis, etc.; and treat other comorbidities/complications at the same time: Comprehensive diagnosis and treatment of other comorbidities/complications with drugs.
There is no trick to chronic diseases. Early screening, early prevention and treatment is the key
Director Yang Yu said: "Renal tubuloacidosis can be regarded as a relatively serious chronic disease to a certain extent. Because of its renal acidification dysfunction, it has a greater impact on the body. It will not only cause obvious complications, but also have relatively poor treatment effects. Therefore, after related symptoms appear, attention should be paid to it and go to a professional medical institution for detailed examination. If it is diagnosed with tubuloacidosis, it should be controlled and treated as soon as possible, otherwise it will cause a circulation deterioration reaction."
In this case, if Li Diadia in this case can undergo systematic and comprehensive examinations to confirm the cause of renal tubular acidosis when there are multiple kidney stones, and improves lifestyles, it can completely avoid removal of most of the kidneys and restore normal life.
Therefore, it is important to screen early for chronic diseases early prevention and treatment. In daily life, we must also eat less sugar and salt, have a low fat and healthy diet, do not smoke, exercise in moderation, take medicine on time and in full, maintain a good attitude, improve cognition, early screening, active treatment, and regular follow-up, and thus maximize the improvement of the prognosis.
(Editor Rainbow.)
Hunan Medical Chat Special Author: Hunan Women and Children's Hospital Liu Meihong
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