A Long and Scary Night

Last night after Annie had been out of recovery for a while, she started retching and dry heaving even though we hadn't started feeding her yet.  In the early evening it picked up and she was having a retching episode every 30-60 minutes.  The natural thing for me to do when she's like that is to suction any secretions or phlegm out of her mouth and throat and vent her stomach through her g-button to release any pressure, or to allow her to "throw up" through her g-tube instead of her mouth.

But when I started venting her stomach last night, a lot of dark green bile started coming out.  It's somewhat normal to see yellow bile out of Annie's stomach even when she's healthy, so at first I wasn't too concerned, but over the next couple hours, the quantity of bile continued to add up to more than 60cc.  And THAT'S not normal!  We put a bag on her tube so we could leave her tube open without having to stand there holding a syringe up to her.  Her tube remained open throughout the night and eventually the rate of the bile slowed way down.  She also got a dose of zofran around 9:00 last night and that seemed to help with the retching.

Shortly after that, around 10pm, Annie's heartrate started dipping into the 50s, and at one point plummeted to 34. (Annie typically runs between 85 and 110.)  The nurse put electrodes on her chest to more closely monitor her heart rate, and they checked her hemoglobin to make sure she wasn't getting too low with her bleeding out the drain in her back.  I put her CPAP on her which seemed to help a little, but her heart rate was still hanging out in the 50s.  Her blood pressure had started dropping too, getting as low as 83/34, and her respirations dropped to 14 breaths a minute  (Annie's normal is 20-30).  Her hemoglobin actually came back at 8.2--which is still low, but higher than it was after surgery.

They started her on a normal saline IV bolus which helped stabilize her blood pressure, but her respirations continued to drop to 10, and her heart rate continued to drop as well, getting as low as 34 and lingering in the 40s and 50s.  This went on for several hours--from 10pm til 2am--and all I could do was sit by her bedside and shake her rather violently when she started dipping so low.  I regularly called in the nurse and the resident expressing my concerns because even when shaking Annie, she remained unresponsive.  They said she was probably just still under the effects of her anesthesia and it could take 12-15 hours to wear off, but Annie has never responded to anesthesia that way before and I knew something wasn't right.  I just wanted to scream at them to give her a stimulant to kick her heart into gear!

Finally the resident came in around 2:15am and asked if she could try shaking Annie with the next drop, and she shook Annie more violently than I did, doing a sternum rub that nearly looked like chest compressions for CPR.  She was able to get Annie's heart rate to spike to 180, but as soon as she stopped, Annie's heart rate fell right back to the 30s!  And even with all that violent shaking, Annie remained unresponsive. 

After watching Annie struggle like this and standing by her for 4+ hours to shake her every minute or two, I started panicking more and more.  She was completely unresponsive and I was so sick of them telling me that this was a side effect of anesthesia because I knew there was something very, very wrong! 

Around 2:15am Annie's eyelids began getting puffy and it was becoming more and more difficult to get her heart rate above 50, even with consistent and strong stimulation and shaking.  I was in absolute awe that no one else saw this as a crisis!  Eventually, the resident suggested getting some labs drawn, and half an hour later the nurse told me that Annie's potassium was 2.8 which is dangerously low! (Normal range is 3.4 - 4.7)  That was the obvious cause of her low heart rate and unresponsiveness, which the nurse agreed.  I was shocked though to hear from the resident that she thought her low heart rate was not related to her low potassium and she was still just having side effects of anesthesia!

Fortunately, they started giving her different IV fluids with an increased amount of potassium.  By 3:30am Annie was stabilizing with heart rates in the mid 50s and respirations in the teens--not great by any means, but they were remaining fairly stable.  I finally felt like she was stable enough for me to try to sleep, but as she regularly dipped below 50 beats and 12 breath , the alarm would sound and I would quickly jump up to shake her some more.

Finally by 6:00am, Annie started stabilizing at regular rates.  They drew new labs which showed her potassium went up to 3.1--still low, but better.  This past night was probably one of the scariest nights of my life.  It's up there pretty high with our day on Thursday with Annie's dangerously high sodium levels an unresponsiveness then too!  I just can't understand why the hospital is having such a hard time balancing her fluids and electrolytes!  I noticed yesterday that her IV didn't contain any potassium, so I asked about that, but was just told that since she had just had surgery, she would just be receiving half saline and didn't need the potassium.  I didn't understand that, but figured that they must be aware of what they were doing. 

Only at 3am did I realize that I should have pushed harder yesterday to get her an IV with potassium in it.  She had become depleted because she hadn't been given any potassium at all yesterday!!  I'm totally baffled at how incredibly poorly managed her fluids have been!  They have put her in critical condition twice in the past two days because of something that should have been easy to manage.  Today my biggest goal is to transition Annie onto pedialyte so we can begin to decrease her IV fluids.  I'm nervous about starting to put stuff in her tummy again because of her retching yesterday and all last week, but she MUST get off these IVs that are not being monitored. 

I find it so ridiculous that I have to be the one monitoring what she is receiving and pushing to get help for her when problems arise.  I can't imagine what would have happened if Annie didn't have a parent here with her last night.  I try not to be too negative or use this blog to vent, but the last couple days have about done me in.  I've never experienced such crisis in Annie's care before, or such a lack of attention to her in crisis!  So we're praying today that Annie will start to tolerate her pedialyte and we'll be able to get her back to her regular feeds in a couple days so we can ditch the IV fluids altogether!