Shit

[Aqua Letifer]

@mark said in Shit:

I hope she quickly takes a turn for the better. I've been keeping you and your family in my thoughts.

+1. Very sorry you and your mom are going through this. I hope things turn around as quickly as possible.

[Jolly]

@Klaus said in Shit:

@George-K said in Shit:

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.

[Loki]

Hoping for the best for you. The roller coaster ride you’ve described is very frightening. It’s amazing though how treatment can turn things around quickly at times.

[kluurs]

Hope things stabilize soon.

[Klaus]

Thanks, everyone!

[Klaus]

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.

[George K]

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.

[Klaus]

@George-K said in Shit:

Causes of seizures, as I'm sure you know are legion.

Actually, I have no clue. How does one find out about the cause?

[George K]

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 “structural” in the brain - tumor, stroke, etc). In your mom’s case, I hope it’s something metabolic and fixable.

[Klaus]

The neurologist chimed in, and according to him the seizures are consistent with the high BUN levels.

[George K]

https://www.epilepsy.com/living-epilepsy/epilepsy-and/professional-health-care-providers/co-existing-disorders/renal-0

[Klaus]

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.

[George K]

Yeah, the creatinine is through the roof as you say. I understand the nephrologists’ thinking, not wanting to burn any PD bridges. However, I’m not aware of that - I’ll 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 she’ll 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.