The Chinese name of otcd is very long and difficult to understand, but it is not difficult to explain.

This is a genetic disease that lacks the urea synthesis cycle and eventually leads to a surge in blood ammonia.

Nitrogen is found in large quantities in proteins, one of the three major nutrients. When the protein enters the digestive tract, it will be dismantled by various enzymes into small molecule amino acids and further absorbed.

Useless nitrogen is metabolized into urea and then excreted through the urinary system.

otcd means that when nitrogen is synthesized into urea, it lacks the enzymes required for synthesis, and the nitrogen after protein decomposition can only stay at the "ammonia" stage. When the blood carries a large amount of ammonia flowing through brain cells, the osmotic pressure of brain cells will continue to change, ultimately causing brain cell edema.

When the edema reaches a certain level, the gradually enlarged brain tissue will be embedded into surrounding gaps and holes, causing brain hernia.

This disease is rare, and most of them start from birth. Even if it has a certain delay, there are still too few people who do not get sick until adulthood.

At least Wang Ting has worked for so long, and none of them have taken over and confirmed that they have been diagnosed with OTCD.

Qi Jing has been working in clinical practice even shorter. He has been specializing in infectious diseases for the first ten years, and it has not been long since he really got involved in genetics. He has naturally seen cases, but he has only seen them simply. No one has ever been diagnosed and treated by his own hands.

While Wang Ting and Zhang Jieyi were still discussing, Qi Jing secretly sent a message to Ji Qing: [The child's blood ammonia is 2,000 yuan]

Ji Qing was in the morning shift today. He took a half day off in the morning and ran to attend a seminar after lunch.

Wang Tingben stayed in the clinic for this critically ill patient. Thinking that Chen Xiao’s partner Zhang Jieyi in the middle class was under a lot of pressure, he simply went to work and helped him to take the shift.

After a while, Ji Qing replied: [So fast? What did Teacher Zhang say?]

【How do you know that Zhang Jieyi is here?】

[Of course you don’t know if you sleep hard every day. Teacher Zhang often comes to see this child]

【He said there was a problem with urea metabolism】

Qi Jing originally wanted to call all the proper nouns, but after typing a few words, he lost his patience because those words were too troublesome to find.

【Well, maybe, I think it looks quite similar】

【I don't think it's like】

[I think why do you always sing the opposite tune with me? We are not in line with each other]

【It’s fun if it’s not up to par, the old rules, a meal】

【Okay, I won’t chat anymore, I will listen to the class】

In fact, Qi Jing was not very sure this time. Many confirmed examinations took time, but the patient's disease progressed too quickly.

The accuracy of judgment is almost the case.

To be honest, his intuition is also a bit biased towards Zhang Jieyi, but the disease that should have occurred so late during the newborn period is definitely a cause.

Before he found the trigger, he theoretically prefers other reasons.

Moreover, this time Qi Jing didn't care too much about winning or losing. Only with losing and winning can he lure others to continue. If he loses, he can't see any hope of turning around. Who dares to play with him?

Moreover, Ji Qing is not rich, so he always asks him to cheat and drink, and finally squeezes his wallet out of the way, and the consequences are also very serious. I remember that Ji Qing broke up with his girlfriend just a few years after working, and spent countless Singles' Days with him.

Qi Jing is not clear about the specific reason, but it should be related to free time and wallet thickness.

Qi Jing smiled and closed the flip phone in his hand: If he loses, he will give him a good meal.

......

Wang Ting couldn't have given OTCD treatment to his child just because of Zhang Jieyi's words.

While dialysis for the child, he found two senior directors of endocrinology and pediatrics to have a brief emergency consultation together.

Zhang Jieyi, who is the most thorough in OTCD research, naturally became the main lecturer. From the first course of the disease at the time of admission to the next few first aid records, the examinations and medications he had performed were all in his mind.

The two directors found it strange that Zhang Jieyi was standing in the lecture hall. Later, they were stunned when they listened to his almost out of scripted case statements.

What's going on? The sun comes out from the west? Why did the oldest gangster in the hospital get serious?

No matter how much they complain, they would just recite it in their hearts a few times. The two looked at each other a few times, but without saying anything, they focused on the case itself.

"Is it arbitrary to determine that OTCD is too arbitrary?" the director of pediatrics suggested. "Although all symptoms and testing indicators are quite consistent, the diagnostic criteria are the concentration of each amino acid in the blood and urine and the activity of the transferase, which takes time to check."

Director Ni, who is endocrine, nodded: "Old Zhang, wait, the result will be produced as early as tonight or the day after tomorrow. Now let's dialysis first and lower the blood ammonia as soon as possible."

"I also know that the report will be issued in two days."

Zhang Jieyi looked very bad. He flipped through a magazine about pediatric genetics in his hand and said: "I don't want this disease either. If it is, subsequent treatment will be a problem."

Hearing this, the two directors gradually became silent.

otcd is an extremely rare disease and has a very urgent disease. The special treatment drugs are sodium benbutyrate and sodium benzoate.

However, these two drugs are not available in China and need to be imported from abroad through environmental approval.

In fact, it is not common even abroad. In 2003, there was only one pharmaceutical factory in the United States that was producing it. It was not until two years later that several pharmaceutical companies participated in the competition.

"If the diagnosis is really confirmed, it can only be maintained by arginine and citrulline." The director of pediatrics took a step back and suggested, "Although there are not many of these two drugs, it is always cheaper than imported sodium benbutyrate and sodium benzoate. Then, it should be no problem to lower blood ammonia on time with auxiliary dialysis."

Director Ni nodded after hearing this: "The medical level is still very limited, so I can only do this."

Zhang Jieyi shook his head repeatedly as he looked at the child's case: "No, there is another way to go."

“What road?”

“Liver transplant.”

"Old Zhang, this is a lot of money, and the patient's family cannot afford it."

Zhang Jieyi said: "The hospital's transplant center was established three years ago. In order to improve surgical skills, as long as the patients' organs are in good condition before the transplant, they will waive some of the costs if the liver source can be guaranteed."

"Where does the liver come from?"

"I've asked his parents to check the matching."

Director Ni frowned: "Old Zhang, you are confused. Even if you waive some of the fees, it is impossible to waive them at all. It is still an extremely heavy burden for the needy families."

"If it's different from what the family members think, the result is a medical dispute!"

"Yes, and the survival rate of liver transplantation is just above 70% within one year, and the survival rate of five years is less than 65%. In the later stage, a large amount of immunosuppressants is needed, which is also a lot of money. What should I do if the family spends money and the people are gone?"

Zhang Jieyi was a little excited after hearing this: "Dialysis is not unexpected and it will not cost money? The quality of dialysis is good and bad. Once the ammonia is not completely reduced, once the drugs are out of stock, the blood ammonia will soar again and cause brain hernia, it will only be more dangerous."

"And this danger lasted throughout his life. I don't know when I walked on the road and fainted on the ground, and the person was gone."
Chapter completed!