No Epinephrine? Then We'll Have to Use the Adrenal Glands

No Epinephrine? Then... We'll Have to Use the Adrenal Glands

Twenty minutes was neither short nor long.

Especially when someone beside you kept asking questions, one after another, and you couldn't kick him away... That really made every second feel like a year.

Gret kept one eye on the child's throat and the other on the priest, gesturing as he explained until his mouth was nearly dry. At last, someone shouted, "It's red! A huge area has turned red!"

Leaning over to look, he saw that the boy's left forearm was smooth and flat, without the slightest problem. But on the right forearm—the spot where the fish broth had been dripped—there was a large red patch. The center was raised, with obvious wheals. Around the outer edge of the redness were thin, uneven red streaks of varying lengths, like insect legs at a glance.

Redness with pseudopods and wheals...

No mistake. It was an allergic reaction, and a severe one at that!

Of course, such a strong reaction might also have been because the fish broth he had prepared hadn't been diluted at all...

Gret felt a little guilty, but he still put on a confident expression and clapped his hands together.

"Confirmed! The cod is the culprit!"

"What next?"

"Next..."

Gret fell silent.

The skin test had identified the cause of the child's illness: acute laryngeal edema caused by an allergy. He knew the emergency treatment by heart and could have written the orders with his eyes closed. In fact, back home, the moment he gave the orders, the experienced emergency nurses would already have prepared the medications:

Subcutaneous injection of 0.1% epinephrine hydrochloride;

10 ml Saline Solution plus 1 mg epinephrine plus 10 mg Dexamethasone, gargle immediately for three to five minutes;

Then 20–40 ml Saline Solution, with 1–2 mg epinephrine and another 10 mg Dexamethasone, for continuous nebulization.

But what did he have now?

Nothing at all!

There was no epinephrine injection, no Dexamethasone injection, not even Saline Solution—any saline he had people mix on the spot would definitely be of inaccurate concentration, full of impurities, and nowhere near sterile...

Damn it!

This life was impossible!

Fortunately, Gret had already prepared a contingency plan for this problem. He pretended to think for a moment, then calmly turned to the farm owner.

"I saw mutton soup in the kitchen. Are the sheep's organs still there?"

"They are, they are!" Uncle Edmond, the farm owner, nodded vigorously. Gret let out a breath of relief. If they weren't, he would have had to discuss slaughtering another sheep on the spot. Rising to his feet, he turned toward the kitchen.

"Bring me the organs!"

After this round of emergency treatment, Gret had established no small amount of authority on the farm. At his request, someone naturally ran to fetch them. Soon, a basin of bloody organs was carried in and set down before Gret with a thud.

Then, under everyone's watchful eyes, Gret squatted down, reached out both hands, and began rummaging through the wooden basin without the slightest hesitation...

The priest, who had been following Gret the whole time, also crouched down curiously. After watching for a while without understanding anything, he could not help asking:

"What are you doing?"

"Looking for an organ."

"Which one?"

The priest craned his neck toward the basin. Roman Knight, who had been following at his side with a hand on his sword, faithfully carrying out his duty as protector, finally could not bear it any longer. He stepped forward and bowed as he interjected:

"My lord, your status is too exalted. Please don't..."

"Eh!" The priest impatiently flicked his sleeve. He stretched his neck, looking left and right, when a gust of foul stench mixed with blood suddenly hit him and nearly knocked him over. If Roman Knight had not supported him, he would have fallen. Even then, he refused to let go of his curiosity. Pinching his nose, he kept asking:

"Which organ are you looking for, exactly? They're just organs. Why not let them find it for you?"

"They don't know."

Without raising his head, Gret searched intently, muttering to himself, "Kidney... kidney... Found it! There's one more..."

"Oh, you're looking for sheep kidneys!" The priest thrust his head closer again. Gret raised a hand covered in sheep blood as if to push him away.

"Stop talking!"

A cold snort came from above and to the left. Roman Knight drew his greatsword and blocked Gret's hand. The blade gleamed with icy light, startling Gret. The priest hastily pulled his big head back as well, grumbling:

"Fine, don't tell me... I was only trying to help you get someone else to look, and you don't appreciate it..."

Gret ignored him and continued searching through the wooden basin with complete concentration. Since the sheep had already been butchered, its anatomy had been thoroughly disrupted. Finding one kidney did not mean he could find the other. After rummaging for quite some time, he finally found both sheep kidneys. Letting out a breath, he carried the ceramic bowl containing them to the table and began carefully separating them.

—From the very beginning, what Gret wanted had not been the kidneys, but the adrenal glands.

Epinephrine constricted blood vessels, while Dexamethasone fought inflammation and suppressed allergic reactions. Dexamethasone was chemically synthesized, so there was no point even thinking about it right now. But epinephrine... At least that was still worth considering.

With that, he could at least reduce the laryngeal edema and let the child breathe normally. Then the chicken bone lodged in his airway could be removed sooner as well.

In theory, epinephrine was a protein hormone and could not be taken orally because it would be hydrolyzed by pepsin. However, there had been cases of oral epinephrine in history. Gret remembered reading such an account in his previous life:

In the autumn of 1893, British physician George Oliver, inventor of the sphygmomanometer, discovered that after a test subject swallowed a substance extracted from goat adrenal glands, the sphygmomanometer could detect constriction in the subject's radial artery.

In later generations, this experiment was regarded as the earliest significant evidence that adrenal extracts could raise blood pressure. But to Gret at this moment, it meant something even more important:

Epinephrine—or adrenal gland extract—really did have an effect when taken orally!

Of course, the child could not swallow right now. But Gret had another hope: among the epinephrine family, neither epinephrine nor Norepinephrine could be administered sublingually, but Isoproterenol could be given under the tongue!

So... adrenal gland extract... More precisely, crushed adrenal glands mixed with water... might have some effect too... perhaps?

Gret was so nervous that he did not even have time to speak. Under the dim light, he carefully peeled away the membrane surrounding the sheep kidneys. Cut, pull apart, blunt dissection... The crude iron scissors flashed lightly in his hands, nearly displaying the dexterity of surgical scissors.

The adrenal glands were tiny, pressed tightly against the tops of the kidneys and enclosed with them inside the renal fascia. Human adrenal glands weighed only five to seven grams, and those of goats could not be much different. He had to be extremely careful to remove them intact. He could not damage them in the slightest.

He had no idea how much active ingredient the two adrenal glands contained, much less how much could be absorbed sublingually. He... had better be careful and waste as little as possible...

Gret focused completely, his movements cautious and gentle. The air he gave off while working gradually affected everyone around him. Even the noisy priest fell silent, leaning over the table to watch without making a sound. The knight beside him coughed, trying to say something, but Gret dismissed him with a wave of his hand.

Only after Gret had completely removed both adrenal glands, placed them in a clean empty bowl, chopped and ground them, then mixed them with water for the child to gargle, did the priest finally let out a long breath and jump up to ask:

"Will this work? Is everything all right now?"

"Let's wait and see..."

Without blinking, Gret stared at the boy's neck, always on guard in case the chicken bone shifted. Fortunately, the child gargled for one minute, two minutes, five minutes... The chicken bone remained firmly in place, while the swelling in his larynx gradually subsided. The sound of air rushing past his vocal cords also became clearer and clearer.

"Wow! It worked! It really worked!"

"Yes, it really worked." Gret secretly wiped away a cold sweat. Pulling out the chicken bone, he smiled tiredly at the priest.

"Next, please step in and heal his wound..."

"No problem! Leave it to me!"

The priest rubbed his hands together and pounced on the child. After the child's condition had been tossed back and forth all night, he could finally be useful. He cast his healing spell with exceptional speed and precision. Once the wound had healed, he straightened his robes, raised his head and chest, and extended his right hand toward Gret.

"Hello, young healer."

******

To write about adrenal gland extract, I spent twenty minutes looking up the weights of various goats in Britain... Goat weights...

Romney sheep: adult rams weigh 80 kilograms, adult ewes weigh 41 kilograms.

Lincoln sheep: adult rams weigh 73–93 kg, adult ewes weigh 55–70 kg.

Southdown sheep: rams weigh 80–88 kg, ewes weigh 60–88 kg.

And so on...

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