Case study and Peds

Hi everyone!
These weeks just fly by before I get the chance to post on the blog! I wanted to update everyone on my case study- to refresh, she has drug-induced fulminant liver failure and has been in the hospital since May 19th. Shes on the transplant list (and has been in and out of the ICU because of encepalopathy) but she had sepsis and an infection and they had to put her on hold on the list until they got that cleared, but on Friday she got activated again! My fingers are crossed that she gets a transplant very soon! I present on Wednesday, so my presentation will be more on the progression of her liver failure, but I thought I would share a general outline of what has been going on. First, she was dietiting when all this went down so she was really not eating much upon admission because of that. Then, she got very encephalopathic and was placed on a hepatic formula. Then, they let her go entirely po again, but she stopped eating well so she was put on Jevity. She then went into acute renal failure so was placed on Nepro, and then she had emesis and was unresponsive so they intubated her. Then They put her back on Jevity but her blood glucose was running high, so now shes on a diabetic tube feed! She has had quite the course, and on Friday I evaluated her and her K was high, so we were thinking she might have to go back on Nepro over the weekend! Shes trying to eat a lot po as well, but her prealbumin was 6 last week regardless of the amount of protein and Kcal that we KNOW she is getting through that tube (granted she has severe ascites...they did paracentesis last week and they drained 5.8 L. SERIOUSLY?!?! Anyways, Im just working away this weekend on the presentation and having a hard time figuring out what to focus on because she has had SO much happen to her. She needs to get a liver fast or she could rapidly decline...so stay tuned!

I was in Peds last week and loved it! The RDs at CMC write the TPNs, and so I have started to get a hang of writing them in the adult world, but the peds world is an entirely different ballgame. They use completely different forms because they base the dosing on mEq/kg rather than mEq/24 hours. This is because the littlest ones change weight every day, so it makes it easy for the dietitians to play with the ratios while also compensating for the weight change of the babies. I think that Peds (as Laurie and Sarah have said) is a place where dietitians are really respected, and the CMC ones do a great job. They have dietitians who work in the outpatient metabolic clinic, the nephrology clinic, and the GI clinic and these women have very frequent contact with their patients and families, whether its when they come in for dialysis every week, whehter they are in and out of the hospital, or whether they write their new TPN orders every week...they have a lot of respect. very cool to see.

enjoy your weekend everyone!
Elizabeth