Healing Doctor

Chapter 291 Sequelae of Ceftriaxone

"The patient has small stones, but they shouldn't affect urination," Director Liu said confidently. "Director Xu, I don't think his kidney function is particularly bad. How about we try dialysis for a few days?"

"I just don't understand why," said Director Xu of the Nephrology Department, frowning. "I know it's none of your business, but..."

She paused as she spoke.

This consultation was indeed a bit absurd, but Director Xu had no choice but to give it a try and see if Director Liu of the urology department had any ideas.

"It has nothing to do with us," Director Liu smiled and repeated.

As soon as he finished speaking, Director Liu suddenly felt his foot being lightly kicked.

It's Ji Xiang!

He was reminding himself!

Director Liu was taken aback, realizing there might be a problem, and immediately recalled the patient's imaging data, medical history, and current targeted treatment.

There's nothing wrong with this patient; they have absolutely no connection to urology!

However, he remained calm, stood up and said, "Let's leave it at that for now. I'll go back and think about it."

"Thank you for your hard work, Director Liu. Please write down the details of the consultation."

"Okay, sure."

After Director Liu and Ji Xiang left the nephrology department, as soon as Director Xu disappeared from sight, Director Liu immediately asked, "Ji, what are your thoughts?"

"Director, the patient is being treated with ceftriaxone at the local hospital," Ji Xiang said in a low voice.

"Ceftriaxone? That's not wrong. It's a broad-spectrum antibiotic that's effective against Staphylococcus aureus, Streptococcus, and Pseudomonas aeruginosa. The medication was appropriate at the time."

Director Liu still didn't know what Ji Xiang was going to say.

"Director..." Ji Xiang didn't know what to say.

"Xiao Ji, just say what you have to say. Don't think that just because I'm the director, I'm above everyone else." Director Liu looked up slightly and said to Ji Xiang seriously.

"The drug information leaflet for ceftriaxone mentions the extremely rare possibility of gallstones."

"..." Director Liu was taken aback; he knew nothing about this.

Ceftriaxone sodium is a commonly used clinical drug with excellent effects, but can it also cause gallstones?

Director Liu was stunned.

"In theory, ceftriaxone sodium has high drug solubility and is less likely to form urinary tract stones."

When blood volume decreases, urine flow rate slows down, or a large dose of medication is administered, the drug concentration reaches its peak in a short period of time.

Ceftriaxone ions react with calcium ions in urine to form ceftriaxone calcium. Because ceftriaxone calcium is poorly soluble in water, it crystallizes in the urine in the ureter, forming pseudo-stones, leading to acute urinary tract obstruction and subsequently acute renal failure. (Note)

Ji Xiang repeated the theory that the system NPC had told him in detail.

Actually, Ji Xiang wasn't very sure either. The NPC's theory was too bizarre; he didn't quite understand how antibiotics could cause kidney failure.

Director Liu listened, completely stunned.

But Director Liu had already given up long ago. It started with the corpus cavernosum puncture, and then one bizarre case after another made Director Liu unable to even think of questioning it.

"How do you diagnose it?" Director Liu asked, frowning.

"Animal and in vitro experiments have shown that the formation of ceftriaxone stones is positively correlated with the concentration of calcium ions and ceftriaxone in urine, and negatively correlated with the concentration of citrate in urine."

"But I'm afraid our Second Affiliated Hospital doesn't have the equipment for an examination, so let's just have a look with a mirror."

Ji Xiang suggested.

"Okay." Director Liu turned around, hesitated for a moment, and picked up his phone.

"Old Gao, it's me, Liu Zhi. Could you take a look at the ceftriaxone instructions for me?"

"Why are you talking so much? I might have encountered a patient with problems."

"It's not an allergy, how could I not know that? Take a look at the ceftriaxone instructions to see if it states that it can cause gallstones."

Director Liu was not embarrassed by questioning Ji Xiang's statement. He held his phone intently, waiting for the pharmacy director's reply.

Ceftriaxone sodium is not metabolized in the body; 60% is excreted through the urinary system and 40% through the bile duct and digestive tract.

If gallstones can form in the gallbladder, then they can also form in the urinary tract, though it is quite rare.

Therefore, he cautiously inquired with the pharmacy director first.

Soon, the phone rang. The pharmacy director on the other end seemed very surprised, and his voice rose several decibels.

Director Liu's orbicularis oculi muscle twitched a few times.

"I understand, thanks."

After hanging up the phone, Director Liu looked at Ji Xiang in surprise.

"Xiao Ji, you even read the drug instructions? And you can even recite them from memory?"

Ji Xiang felt somewhat ashamed, realizing that he didn't know how to do it himself; it was all thanks to the system NPCs who gave him cheat codes.

Seeing that Ji Xiang's expression was different, Director Liu smiled and patted Ji Xiang's shoulder.

"That's a good thing. I'm not jealous of anyone's talent. Xiao Ji, come with me to be a mirror later."

"Yes, Director."

Without further hesitation, Director Liu turned around and went back to find Director Xu.

"Director Liu, why are you back? Did you leave anything behind?" Director Xu of the Nephrology Department was taken aback.

"Xiao Ji reminded me, and I suddenly remembered something."

Director Liu "translated" Ji Xiang's words again. Although some parts were missing, Director Xu from the Department of Neurology was able to understand them.

"Director Liu, how come I've never heard of this?" Director Xu asked without hesitation.

"I'm going to make a mirror so I can see myself clearly, whether there's something wrong or not."

"Make a mirror?" Director Xu was stunned; she didn't understand why they needed to make a mirror.

"Director Xu, you haven't made a diagnosis and don't know what's going on. I've suggested a possibility, but you don't believe me." Director Liu's face immediately fell. "If you don't want to, I'm going back. I'm exhausted after a day of surgery. Who wants to have an emergency endoscopy?"

"Don't be like that!" Director Xu immediately smiled apologetically. "Director Liu, look at you. I just don't understand why you're angry. You're not usually like this, don't be so petty."

She checked the records before sending the patient to the urology department.

After using ceftriaxone for so many years, Director Xu, like Director Liu, was unaware that it could potentially form kidney stones.

"Director Liu, are there any other diagnostic methods?" Director Xu asked casually.

"Xiao Ji, you say it." Director Liu said smugly.

"The most reliable method for diagnosing ceftriaxone stones is infrared spectroscopy analysis, but our Second Affiliated Hospital has not yet carried out this type of examination."

Diagnosis still requires consideration of the patient's medical history. When a patient develops renal colic symptoms after recent use of ceftriaxone sodium, accompanied by sudden onset of oliguria or anuria, the possibility of acute post-renal renal failure caused by ceftriaxone stones should be considered first.

"Although the likelihood of it happening is low, it does occur occasionally."

"..."

Upon hearing Ji Xiang's explanation, Director Xu became quite upset.

Ji Xiang's explanation was so professional that Director Xu only half understood it, which made him feel somewhat embarrassed.

……

……

Note: I wrote about ceftriaxone causing gallstones in the early days of the live broadcast, but I didn't know it could also cause kidney disease. I was very surprised when I found the paper.

Source: Journal of Clinical Urology, Issue 3, 2015.

(End of this chapter)