Author of this article: Well.J Adapted from real cases < strong>01. < /span>It was night and there was no noise in the emergency room: not a good sign. “Xiao Wang, would you like coffee? Order a cup for you?” “No more, I usually drink That thing will make my heart palpitate.” At that time, I was sitting in the clinic, and took advantage of the rest to watch a short video. Suddenly, there was a commotion outside. When I went out, I saw a confused young man with a young face and a strong body. After asking about the basic situation, the nurse quickly started ECG monitoring.The patient’s breathing rate was normal, but the heart rate was very fast. “What about blood pressure, how much?” “Blood pressure machine can’t measure it!” “330/180!” Finally, invasive arterial blood pressure monitoring can be used to obtain specific values. I swear, I have never seen such high blood pressure in my life, so I quickly asked the patient’s family: “Does your son or family have a history of hypertension?” “Impossible! My son is only 25 years old and has always been healthy. Today I heard some strange movements in his room, and I went in and found that he had fainted on the ground.” A 25-year-old, previously healthy, with no history of disease, sudden severe hypertension, my head is chaotic: This world’s high blood pressure Common, but so high true First time seeing it. My brain is racing at the moment, basically ruling out the possibility of primary hypertension in this young patient. There is a high probability that it is a secondary – “drug” effect? While prescribing emergency blood routine, blood biochemistry, liver and kidney function electrolytes and other packages, I asked the patient’s family, “What does the patient usually take for a long time? Medications? Or, have you taken any meds lately that you shouldn’t be taking?” I tried to be a little more euphemistic about the question of drug use, but I hope the family will understand. Unexpectedly, the patient’s mother refused, insisting that her son was in very good health and had basically never taken any medicine. But indeed, the results of the check and feedback are basically all normal, and according to the patient’s body shape, it does not look like an addict. My train of thought was interrupted again, and then I was called by the nurse. “Doctor Wang, what’s the next step?” Glancing at the monitor, the patient’s heart rate is so fast, I can’t help but suspect that it may be an undiscovered heart disease. Immediately, a quick physical examination was performed on the patient, but an unexpected discovery was made. New physical examination tips, The patient’s pupils are not equal in size, with one pupil being significantly larger than the other< /strong>. A few possibilities flashed through my brain: Hidden head trauma? Intracerebral Hypertension Cerebral Edema? Or pesticide poisoning? Li, who was on duty with me at this time, suddenly said weakly, “Isn’t it a brain herniation?” There is only one sentence in my heart: You kid, but shut up for me. 02. While we are waiting for the CT report At that time, the patient’s mother suddenly found me again, and she handed me a mobile phone, which kept popping up a prompt from a short video software: “5789 people have commented on you, and 9374 people have liked your video.” The number continues to rise. But I can’t take care of this for the time being. I quickly clicked on the doctor’s order system, typed in the words “mannitol”, and then sent a consultation between neurology and neurosurgery. . Fifteen minutes later, the results of the emergency CT came out, and Xiao Li and I immediately put our heads together. I don’t know if I don’t see it,CT shows that the patient has very obvious large cerebral hemorrhage and cerebral edema, and the normal brain tissue has been compressed , “Looks like emergency surgery.”
This case) Source: Wikipedia At this time, the patient’s blood pressure and heart rate did not drop, but fortunately, the doctors inside and outside the gods who just called out have already come downstairs. The emergency surgery was not my turn, so I went back to my clinic after the handover. On the way back, I saw the patient’s mother, and I was unwilling to ask the patient’s trauma history again, but the answer was still no. At this time, the middle-aged woman handed me the patient’s mobile phone again, and she was so excited that I had to take a look. “Maybe I can find some clues on my phone?” Ithought. I took the phone and took a closer look. I found that the number of fans of the account on the home page is not very large, but the last video was very popular, breaking 50w likes. Coincidentally, it was the patient himself who posted a new video with a similar cover a few hours ago. Curiosity led me to click on the video. In the latest video, the patient opened a can of similar health products, showed the powdery substance inside to the camera, and then ate four spoonfuls in a row. After entering the mouth, the patient’s expression was very painful, and it seemed that he was choked. So he got up and picked up the cup. Naively, I thought he was going to pick up the water for a while, but I didn’t expect this guy to add four spoonfuls of water. . My mouth was wide enough to swallow five eggs – and honestly, I’ve never seen someone so deadly. After this, the patient is ready to start exercising. But the strange thing is that, before he touched any sports equipment,he started to sweat profusely, and after lifting the dumbbell twice, he fell to the floor, eyes closed, hands Pressing on his chest, it really doesn’t seem like a normal person’s reaction. He looked miserable. I quickly clicked on his last video again and found that both of his videos were eating the same powder. In the last video, he was relatively normal and only ate two spoons. “Is this the boldness of the legendary artist?” < strong>03.< /em> Old dog like me quickly clicked on the comment area. It turned out that the patient is a short video blogger in the fitness area, and there is no big splash in the videos he usually posts about his fitness. Sometimes ago, there was a new trend that I don’t know where, and many bloggers in the fitness area suddenly began to recommend dry eating of a certain brand of fitness granules. Because the brand promotion states – “Dry eating can bypass water for better absorption by the body and produce better effects“. Although the package states “no more than two scoops per day,” my patient apparently chose to ignore this statement. After tasting the sweetness of the last “Two Scoops” video, he chose to challenge the limit again: Eight scoops of fitness powder, bang bang Just eat. Just when I hadn’t figured out what the eight spoons had to do with the patient’s sudden disturbance of consciousness, Xiao Li, who had been peeking behind me for a long time, actively spoke: ” Is there any problem with this thing?Maybe the high blood pressure causes blood vessels in the brain to rupture and hemorrhage, resulting in brain edema, and then the increase in intracranial pressure leads to disturbance of consciousness strong>.” Dude, this kid finished my lines. I opened my mobile phone and searched for the blogger’s account, clicked it and read it twice. “Little Li, can you see what he’s eating? My eyes really don’t seem right.” span>Xiao Li glanced at me with a look of caring for the elderly, and then clicked the big words “commodity window” in front of me, and then the products were displayed. I clicked on the link and started reading the product’s ingredient description,I found out that this workout contains caffeine, creatine and a Unidentified polymers composed of various substances, etc..
Source: Video provided by the original case doctor
ingredients Description, In this fitness bolus, beta-phenethylamine is described as “helping to maintain focus, maintain a good mood, and maintain alertness.” (Source: Brand Official Website) β-phenethylamine? I think of another phenethylamine, alpha-methylphenethylamine, sometimes written as amphetamine, which is a A central nervous system stimulant used to treat attention deficit hyperactivity disorder, narcolepsy, and obesity.
Chemical formula of α-methylphenethylamine (Source: Wikipedia)– Phenethylamine is closely related to another well-known substance, methamphetamine, also known as methamphetamine. The crystal form of the latter is commonly known as methamphetamine and slang “pork”. It is a potent central nervous system stimulant mainly used for drugs and occasionally for treatment Attention deficit hyperactivity disorder and obesity.
methamphetamine chemical formula (image source:Wikipedia) span> And their “good brother”, beta-phenethylamine, is also approved for dietary supplements and fitness supplements, etc.
Medical methamphetamine tablets (Source: Wikipedia)
It’s just that all those who have studied medicine know that taking high doses of methamphetamine can cause psychosis, rhabdomyolysis, generalized epilepsy and intracranial hemorrhage caused by central nervous system stimulation. Overdose can also cause mild brain damage due to dopamine-activated and serotonin-activated neurotoxicity. Although β-phenethylamine can be rapidly broken down or metabolized in the brain compared to α-methylphenethylamine, when human Excessive intake of β-phenethylamine at one time, the body has no time to catabolize it, and it will also cause the substance to stay in the synaptic cleft for a long time. The long-term existence of these substances will have a continuous stimulation effect on the postsynaptic membrane and stimulate the continuous excitation of the central nervous system. It increases cardiac contractility, excitability, conduction acceleration, cardiac output, and heart rate; at the same time, it strengthens the contraction of blood vessels and increases blood pressure. go hereThe patient’s cause finally became clear. Later, I read the patient’s inpatient diagnosis and treatment in Brother Zhang’s circle of friends, and I was a little embarrassed when I learned that he was regarded as a typical case, but my life finally ended. It was rescued, and it was also a blessing in misfortune. After another period of time, when I almost forgot about this patient, I swiped his latest video one afternoon. He seems to be recovering well in the video. He told his own experience earnestly and reminded all fans who follow him to take medicines scientifically and rationally under the guidance of doctors and instructions, and not to repeat his mistakes. And I picked up the coffee I bought for refreshment after lunch and took a careful sip. (curated by: carollero, gyouza) Thanks to Bernard Hsu (@Chubbyemu), University of Illinois for providing and licensing this case< /span> Acknowledgments: This article was diagnosed by mechanical ventilation in Lilac Garden Lecturer of open courses, Master of Immunology, Third Military Medical University @The Little Prince of Ventilator Professional ReviewSource of title map: Dragon TV “Emergency Room Story” Season 2References: [1].@Chubbyemu YouTube video, details provided by Chubbyemu himself[2].People’s Health Publishing House “Internal Medicine”[3] .Yu S, Zhu L, Shen Q, Bai X, Di X. Recent advances in methamphetamine neurotoxicity mechanisms and its molecular pathophysiology. Behav. Neurol. March 2015, 2015: 103969. PMC 4377385. PMID 25861156. doi:10.1155/2015/ 103969.[4]. Malenka RC, Nestler EJ, Hyman SE. 15. Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience 2nd. New York: McGraw-Hill Medical . 2009: 370. ISBN 978-0-07-148127-4. [5]. Krasnova IN, Cadet JL. Methamphetamine toxicity and messengers of death. Brain Res. Rev. May 2009, 60 (2): 379–407. PMC 2731235. PMID 19328213. doi:10.1016/j.brainresrev.2009.03.002.[6 ]. Corti R, Binggeli C, Sudano I, et al. Coffee acutely increases sympathetic nerve activity and blood pressure independently of caffeine content: role of habitual versus nonhabitual drinking. Circulation 2002; 106:2935.[ 7]. Nehlig A, Daval JL, Debry G. Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects. Brain Res Brain Res Rev 1992; 17:139. span>Lilac Garden RecruitmentJob Name: New Media Operation (Lilac Garden) Complete original content planning independentlyAssist in the operation of Lilac Garden official account WeiboWork location: HangzhouClick here to directly Submit your resumeYou can also send your resume to the mailbox[email protected]Subject: Post Name-Name