Queenie's 微笑的黃金

971205  8PM~ 971206  8AM 這是我第二天的晚班

ER門內  溫暖得多  我是說相比今天門外冷到不行的寒流  根本就是打開冷凍庫的感覺  

大半夜裡聽到留觀區裡打鼾聲很大的p’t  真好睡  

這天晚上C/O多會是有chest pain來的  外加那種本質很psyche嘴裡可以嘀咕出一串我要打什麼藥才治得好當下問題的p’t

ER醫師對所有一般影像的判讀和了解  還是不忘提醒我們這些跟班

〝看片子首要就是要看名字和拍照時間對不對 免得解釋錯  再來就是要仔細看  p’t來了照片子了   就是要好好看  沒看到問題就是該檢討的 〞
 

昨天晚上是朱Dr.和鄭Dr.  發現朱Dr.是個很溫的爸爸  一個看起來很像徐Dr的爸爸  像光良……  

這天晚上孩不少那種coma的case 合併有liver cirrhosis 的問題 這塊領域真的在我們病房裡少見的多  data showed出來都是ammonia過高  

Ammonia, Blood

Normally, ammonia is converted into urea by the liver and then excreted by

the kidneys. If a physical disorder prevents this conversion from occurring, the

ammonia accumulates in the bloodstream. Toxic levels of ammonia in the blood

lead to a problem known as hepatic encephalopathy (肝性腦病變), in which brain function is affected by the high ammonia levels.

Correlation between plasma ammonia and the degree of encephalopathy can be erratic. For example, an individual with very high blood ammonia may show minimal or no effect while another may be greatly affected. 

The test can be used to determine whether liver dysfunction is the cause of such symptoms as confusion, excessive sleepiness, coma, or hand tremor. It can also be used to monitor the effectiveness of treatment for liver disease, such as cirrhosis. 

Normal Values

Possible Meanings of Abnormal Values  

Increased  Acute bronchitis ,Azotemia(氮血症), Cirrhosis, Corpulmonale, Gastrointestinal bleeding, Heart failure, Hemolytic disease of the newborn

Hepatic encephalopathy, Hepatic failure, Hyperalimentation( 高營養治療法), Leukemia, Pericarditis, Pulmonary emphysema, Renal failure, Reye’s syndrome

Decreased  

Essential hypertension

Malignant hypertension 

Treatment is aimed at reducing the production of nitrogenous wastes by reducing protein intake and the metabolic activity of intestinal bacteria. Lactulose is the current mainstay of therapy. Lactulose(半乳糖)is a synthetic Disaccharide(雙糖)containing one molecule of galactose and one of fructose. It is minimally absorbed into the bloodstream. 

Lactulose can be given orally or rectally. The oral dose is 20 g in a glass of water, fruit juice, or carbonated citrus beverage. For rectal administration, 300 mL of lactulose syrup is diluted with 700 mL of water(retained for 30 min) or normal saline. The enema should be retained for 30 min. 

Antibiotics such as neomycin and rifaximin directly inhibit bacterial growth and protein metabolism, so they are not given intravenously for hepatic encephalopathy. Neomycin can cause nephro- and ototoxicity, whereas Rifaximin apparently does not.