Recently, there was such a patient in my bed. The child, male, 1 year and 5 months old, had an acute onset; he was admitted to the hospital with “fever for 3 days” and had a recurrent temperature, the highest temperature was 40.2℃, with nasal congestion, runny nose and occasional cough; on examination: pharyngeal congestion, coarse breath sounds in both lungs, no abnormality in the heart and abdomen; routine blood tests + CRP were approximately normal; he was treated with various antipyretics and antibiotics at the local hospital (specific He was treated with various antipyretics and antibiotics (specific) at the local hospital. After admission, he was given Xiyampin and vitamin infusion, and oral Chaihuang granules for symptomatic treatment; the relevant tests were completed: negative respiratory virus antigen; normal mycoplasma pneumoniae and chlamydia; liver function ALT 421 U/L and AST 368 U/L. According to medical practice, it is recommended to complete the pathogenic examination of liver damage, improve relevant imaging examinations, and give liver protection treatment. However, the child’s parents were both 20 years old, the mother was unemployed and the father worked part-time, and this was the second time that the child was hospitalized because the fever could not be reduced at the outside health center. So after full communication with the family, I made a decision not to do any more tests and treatment, and the child was discharged after 36 hours of normal temperature and 4 days of total hospitalization. One week after discharge, I rechecked liver function transaminases 2, ALT 81 U/L, AST 70U/L. I. What made me make this decision is my kindness and my understanding of liver function damage. My understanding: 1. ALT, glutamate aminotransferase, normal reference value is 0~40 U/L, mostly soluble cytoplasmic ALT; 2. ALT is a protein, mainly present in hepatocyte plasma, intracellular concentration is more than 100 times higher than in serum, as long as the liver is slightly damaged, it can make serum aminotransferase significantly higher; 3. The half-life of plasma ALT is 37~57 hours; the hepatocyte The apoptosis time is about 1 year, that is, the half-life is about 180 days, related to infection, poisoning, environment, diet, exertion, psychological factors, etc.; 4, the liver has a strong regenerative and recovery ability, only one-fifth of the healthy liver, liver function tests can be normal, the removal of 75% of the liver, about 4 months after the liver can repair itself; 5, liver cell damage can cause ALT elevation; at the same time, the blood due to If the protein “ALT” is elevated due to some factors, ALT will also be elevated, but it has nothing to do with liver damage; 6, liver function tests include: enzymatic tests, synthetic function tests, secretion and excretion function tests, liver regeneration function, etc. So when we come across abnormal liver function, we should not think of protecting the liver first, but to remove the factors that cause liver function damage. Because the liver is really powerful, as long as the cause is removed, the liver will soon repair itself, as for the use of liver protection drugs really does not mean much. The first thing I would like to do is not to consider congenital, genetic, genetic, metabolic and other causes for the time being, but it is not 100% ruled out that some of them start at different ages. 2, again seek to ask the medication, with nimesulide (Riziqing), ibuprofen, acetaminophen and other antipyretic, with Zithromax, cefixime anti-infective, and other proprietary Chinese medicine. So I consider the possibility of drug-related liver injury; 3. The child’s fever, a high fever, blood routine + CRP normal, consider the possibility of viral infection. It may be the virus that causes respiratory infection causing liver damage. 4, the general condition of the child is good, the examination of the liver is not large, except for ALT elevation, the remaining liver function albumin (synthetic function), total bilirubin (secretion and excretion function), AFU (liver regeneration function) are normal, simple ALT elevation, indicating that liver cell destruction is not serious. So I first remove the suspected drug factor, viral infection is mostly self-limiting, the factor is also automatically removed; after removing the factor, ALT in the body after 5 half-lives (37 × 5 ÷ 24 = 7.7), about 8 days will drop to normal; ALT 421 U/L, by calculating about 5% hepatocyte damage, and then calculate the self-replacement of 5% damaged hepatocytes takes about half a month; the liver has such a strong regenerative and recovery The liver has such a strong ability to regenerate and recover that the liver function will recover quickly after removing the factors. Of course, I also signed with my family that if the ALT did not improve, I would need to be hospitalized again to improve the tests. In the end, my judgment proved to be right, and this is how “miracle doctors” are trained.