Shit
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OK - CPAP is much better than being on a ventilator. Presumably she's not intubated.
Uremia can cause the symptoms that you described in your original post - diarrhea, nausea, vomiting, and ultimately confusion.
Hopefully they'll get her BUN down as quickly as safe.
Inserting a temporary hemodyalisis access port is not a big deal. That would be a reasonable thing to do if the PD isn't working.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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Hopefully they'll get her BUN down as quickly as safe.
From what I understand, her BUN level was well over 200 <insert some unit whose name I forgot here, mg/dl?>, which normally is supposed to be below 20.
Anything that high, I don't even titrate, just report out as >150.
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Latest update: On the positive side, BUN is getting better, lung is still good. On the negative side, there are new problems. She had multiple seizures this night. She was intubated to prevent suffocation. Still very somnolent - this should have improved due to the improved BUN levels. They checked for meningitis (analysis of spinal cord water), but with no result. Next up: MRT of the brain, neurology dep. gets involved. As far as I understand, they are puzzled about the seizures because they fit neither to the BUN problems nor to COVID-19.
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Man, that's rough. The falling BUN is a good thing, to be expected with dialysis (are they doing HD now?).
Causes of seizures, as I'm sure you know are legion. Anything from metabolic issues, to drug interactions, to intra-cerebral events.
Hopefully they'll get a handle on what's causing this - MRI is cartainly a good first step.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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Diagnosing the cause of seizures is frequently a matter of eliminating stuff (like the stuff I mentioned above). The important thing is to rule out something âstructuralâ in the brain - tumor, stroke, etc). In your momâs case, I hope itâs something metabolic and fixable.
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Thanks for the link! That seems to be exactly what they explained.
The nephrologists also explained why they stick to PD. According to them, if they switch to HD, even it's only temporary, it may make it impossible to ever go back to PD. BUN and creatinine levels are still very high (something like 150 for BUN now; creatinine was supposedly at 17, which, as far as I understand it, is also through the roof), hence it's not a miracle that things get better only very slowly.
@George-K do you have insight into the kind of effort that it takes to perform a MRI of an ICU patient who is presumably connected to all kinds of devices, can hardly breathe etc. and - in this case - is infectious with COVID-19. I guess that must be a massive amount of work and organization.
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Yeah, the creatinine is through the roof as you say. I understand the nephrologistsâ thinking, not wanting to burn any PD bridges. However, Iâm not aware of that - Iâll defer to their judgment.
As far as the logistics of scanning an ICU patient, they are, to say the least, a nightmare. There are all kinds of devices used in the ICU which are not MRI compatible (infusion pumps, etc). However, for the brief period (less than a hour, hopefully) that sheâll be in the tube, I imagine any infusions can be suspended, or tubing can be added to keep the pumps out of the scanner room while still working. THere are MRI compatible ventilators also. We had an actual MRI compatible anesthesia machine that, of course, has a built-in ventilator that we would use.
I hope things turn around as quickly as possible.