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Abstract: This case is a 51-year-old male who came to the hospital 1 year ago for dizziness and was diagnosed with lacunar cerebral infarction after examination. He was given oral aspirin enteric tablets to inhibit platelet aggregation and began to develop bilateral lower limb edema six months ago, which was progressively aggravated, and in the last month, he had generalized edema with abdominal distension and scanty urine. After coming to the hospital, he was diagnosed with protein-losing enteropathy by gastroscopy, aspirin was stopped, and medication + nutritional support was given. After treatment, the patient’s abnormal indexes returned to normal and the symptoms subsided.
Basic information】Male, 51 years old
Disease Type】Protein-losing enteropathy
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】April 2021
Treatment plan】Discontinuation of aspirin intestinal tablets + medication (compound danshen drops + rehabilitation new liquid + pantoprazole sodium intestinal tablets + intravenous human immunoglobulin (pH4) + human albumin) + nutritional support
Treatment period】2 weeks of inpatient treatment, long-term follow-up
Treatment effect]: General edema subsided, urine output normalized, abdominal distension relieved
I. Initial consultation
The patient was 51 years old, admitted to the hospital from the outpatient clinic with edema to be investigated. In the past six months, he had alcoholic fatty liver, no cirrhosis, quit drinking for one year, had lacunar cerebral infarction, which had been treated for one year, no dizziness at present, and no history of heart disease, kidney disease, tumor, etc. He took aspirin enteric soluble tablets orally for six months, and took no other drugs. Suspecting whether the patient had gastrointestinal tumor or gastrointestinal absorption disorder, he applied for gastrointestinal microscopy, which showed that the patient had light and heavy erosions and edema in the mucosa from the stomach, duodenum, jejunum, colon to rectum, and small ulcers in some intestinal segments, and no tumor lesions were found. The serum examination indicated albumin 21.2g/L and globulin 11.4g/L, with severe protein depression. Combined with other examinations, the first diagnosis was considered to be gastrointestinal mucosal damage caused by long-term oral administration of aspirin enteric tablets, resulting in protein-losing enteropathy.
II. Treatment history
After the diagnosis was clear, further treatment plan was formulated. After the patient was admitted with lacunar cerebral infarction and re-examined with cranial MRI, a neurologist was consulted, and the patient’s lacunar infarct lesion did not progress and clinical symptoms were reduced. However, the patient was given human albumin and human immunoglobulin (pH4) for the abdominal distension and discomfort due to the severe hypoalbumin and globulin, extravasation of plasma, and decreased immunity of the body, and encouraged the patient to eat high-quality protein, such as fish and chicken, and to increase the intake of eggs, milk and soy products appropriately.
III. Treatment effect
After 1 week, the patient’s abdominal distension was relieved, the edema subsided, and the diet increased, and the intravenous infusion of human albumin and intravenous injection of human immunoglobulin (pH 4) was stopped. After the treatment of repairing the gastric mucosa, the patient’s appetite increased significantly, and the digestive and absorption functions were enhanced after eating high-protein food, the serum albumin was close to normal, the globulin was back to normal, and the ultrasound indicated that there was no fluid in the abdominal cavity. After stopping aspirin, no dizziness, headache, weakness and other uncomfortable symptoms appeared, and continued to observe the change of condition.
IV. Precautions
The patient’s condition gradually improved after treatment, and I felt very relieved. The patient’s condition gradually improved, but the following points still need to be noted to prevent recurrence of the disease.
1, diet should still pay attention to avoid spicy and cold food, drinking alcohol, strong coffee, carbonated drinks, strong tea, etc. to stimulate the gastrointestinal mucosa, causing re-injury to the gastrointestinal mucosa.
2, continue to maintain a high-protein, low-fat, vitamin-rich diet structure, not only to ensure a continuous high-quality protein supplement, but also to prevent the rise of blood lipids.
3. It is still necessary to closely monitor the neurological changes, regularly consult a specialist for evaluation and, if necessary, reuse drugs that inhibit platelet aggregation under the condition of protecting the gastric mucosa to prevent the aggravation of cerebral infarction.
V. Personal insight
Protein-losing enteropathy is a syndrome in which various causes cause damage to the gastrointestinal mucosa, causing proteins in the blood vessels of the gastrointestinal wall to be discharged from the gastrointestinal tract. It is not rare clinically, but the diagnosis rate is not high, especially in elderly patients with chronic underlying diseases, and the decrease in albumin and globulin easily causes edema, indigestion, abdominal distension, and immune deficiency, so patients and physicians are reminded that while treating chronic diseases , there are many kinds of oral medications, we must pay attention to the gastrointestinal damage factor to avoid drug-related damage that leads to albumin decline or malnutrition.