Almost the end.

What a day. Today I have had quite a few challenging heme/onc cases. My most difficult case was a young man with AML who currently has GVHD of the gut/skin/liver, a pneumothorax, decreased urine output, potential liver failure, and BK virus in his brain. The patient's MD indicated he has never seen a patient with BK virus in the brain. I know the medical team is similarly overwhelmed with how to manage the patient. Anyhow, he is on TPN, which was actually discontinued yesterday due to fluid overload. His triglycerides and lipase are elevated. The current debate is whether or not to remove lipids from his TPN. The TPN pharmacist said lipase is not needed to digest IV lipids, but if his TG are super elevated that may be a reason to discontinue lipid administration. The patient is intubated and sedated and has a number of other medical complications that are too complex to explain at this time. Anyhow, from a nutrition perspective, we are currently waiting for the TPN orders to be reinitiated and then we will restart his parenteral nutrition. His labs will be measured again before writing the order. Today his potassium was elevated, and he had diarrhea. Complex. Diffcult to treat, but much more difficult to observe. The most challenging aspect has been juggling what to focus on with abnormal labs, diarrhea, liver failure, fluid overload, etc. All nutrition efforts seem contraindicated....

Well, tomorrow is officially my last day. Still cannot believe this summer has passed so quickly. I have learned a ton and feel much more prepared to enter the field. Exciting.

Rachael