第一次查房（1993年9月7日） 进修医师:报告病史。患者女,49岁,农民。因腿痛9月,多饮、多尿4月,四肢瘫痪1天于1993年9月5日入院。9个月前,无明显诱因,出现双下肢疼痛,以左大腿骨骼疼痛为明显,并腰痛及左胸肋疼痛,症状进行性加重。4个月前出现口渴,多饮,每天饮水量约2500ml。喜食稀粥,并尿多,夜尿频,每晚尿量约2000ml。无尿痛。1天前于宴餐后出现恶心、呕吐,腹泻黄色水样便。极度疲乏,随后四肢瘫痪。无糖尿病、肾炎及肾盂肾炎病史。查体:T37℃,P83次/分,R25次/分,Bp12/8kPa。身高151cm,体重35.5kg。消瘦,脱水貌。表情淡漠,反应迟钝。声音低微。皮肤弹性差,淋巴结无异常,巩膜无黄染。甲状腺不大。心肺正常。腹平坦,软,肝脾未触及。双肾区无叩痛。双下肢不肿,四肢肌力 First rounds (September 7, 1993) attending physician: report the medical history. Female patient, 49 years old, farmer. Due to leg pain in September, drink more, polyuria in April, limbs paralyzed 1 day in September 5, 1993 admission. Nine months ago, there was no obvious incentive for bilateral lower extremity pain. Obvious left thigh skeletal pain was noted, with low back pain and left chest pain. The symptoms worsen. 4 months ago appeared thirsty, drink more, drink about 2500ml daily. Eat gruel, and urinary, nocturia, urine output of about 2000ml per night. No dysuria. 1 day ago after the feast nausea, vomiting, diarrhea, yellow watery stools. Extremely tired, then paralyzed limbs. No diabetes, nephritis and pyelonephritis history. Physical examination: T37 ℃, P83 times / min, R25 times / min, Bp12 / 8kPa. Height 151cm, weight 35.5kg. Thin, dehydrated appearance. Indifferent expression, unresponsive. Low sound. Poor skin elasticity, no abnormal lymph nodes, sclera no yellow dye. Thyroid is not big. Cardiopulmonary normal. Belly flat, soft, liver and spleen not touched. Kidney area without knocking pain. Double lower extremity is not swollen, limb muscle strength