Saturday, October 21, 2006

10/21/06 - NICU Day #19

Nurse: Michelle
  • Anuria continues. Complications of the fluid and electrolyte retention have developed.
  • The potassium is relatively stable at 6.1. After yesterday's rectal bleeding, kayexalate is being held and he is just being maintained on insulin and glucose. The abdominal radiographs are unremarkable and his belly is soft.
  • The hematocrit this morning is also down (28.9) and he will require a transfusion -- adding to both his fluid and potassium load.
  • Yesterday evening, the increasing retained fluid in the lungs required higher and higher mean airway pressures to maintain oxygenation. Simultaneously, the blood pressure began coming down. A new attending on service for the weekend felt that Daniel's blood pressure would do better on the conventional ventilator and switched him over. This was done simultaneously with increasing the dopamine to 12 (from 10). His blood pressure improved -- although I'm not sure it was the ventilator change or the increased pressors. Predictably, PIE worsened and he developed a pneumothorax on the midnight CXR. Two chest tubes were needed to re-expand the lung. He was then switched over to the Jet ventilator. I'm still waiting for the morning chest X-ray.
  • The rectal bleeding stopped last evening after Daniel got FFP. According to his nurse, his coags were normal but the FFP was given prophylactically because of three bloody diapers. He's still getting Q6H X-rays, antibiotics, and bowel rest.


milana said...

evan jen and daniel - my thoughts are with all of you on this difficult weekend. thank you again for sharing so much with us.

Judy said...

I visited Daniel today. Although his health is very fragile, and we are all very worried about him, his appearance belies all that. He is such a beautiful baby and appears perfect in every way. He is sedated but occasionally moves his small but perfectly formed arms and legs. When I saw him, he was being cared for by two nurses who were very gentle with him. He is a sweet baby and you can't help but love him.