The medical field amazes me with how much is understood despite how complicated and intricate the body is. For the last several days something called metabolic acidosis has been addressed and is being tackled. Our bodies ideally maintain an acid-base balance and the kidneys play a major role in regulating it. Because Ashtyn’s kidneys are damaged from all the chemotherapy and countless medications, they are not maintaining enough bicarbonate, which is the most important chemical to maintain acid-base balance. Without IV acetate (which converts to bicarbonate in the body) her bicarbonate level dropped to 9 with a low, acidic pH of 7.10. Normal levels are 23 and 7.35. Having metabolic acidosis made her feel awful from head to toe a couple days ago. She stayed in bed all day with zero appetite, zero energy, and a headache. Once the team knew how low her pH could go before becoming symptomatic, acetate was added back into her IV fluid, bringing her levels up to where she felt good again. The information enabled the team to know how much acetate to give Ashtyn so she’ll feel good and at the same time keeping the level low enough to remind the kidneys to work.
At this point it cannot be predicted whether or not her kidneys will fully recover or not. In the meantime, she’ll receive IV fluids with sodium acetate, magnesium, and phosphorus for twelve hours each night, even at home. In addition, she takes oral potassium and bicarbonate. Her stomach needs to heal further to be able to tolerate oral magnesium and the high level of bicarbonate she needs in order to get off IV electrolyte fluids all together. I suspect Ashtyn will get out of the hospital by Thursday. We will then stay at the Ronald McDonald Apartments, which is different from the Ronald McDonald House. The apartments are for BMT patients, isolating them from germs and anyone who could be sick. The day after leaving the hospital we will meet with the outpatient BMT team at Seattle Cancer Care Alliance to talk about the possibility of getting her home before Thanksgiving. A few things to pray for: 1. That the Adenovirus will stay under control. The level recently jumped from 1700 to 8500. 2. That she’ll need platelet transfusions only 1 to 2 days a week instead of the current 3 to 4 days a week. 3. Her stomach, bowels, and kidneys will heal.
At this point it cannot be predicted whether or not her kidneys will fully recover or not. In the meantime, she’ll receive IV fluids with sodium acetate, magnesium, and phosphorus for twelve hours each night, even at home. In addition, she takes oral potassium and bicarbonate. Her stomach needs to heal further to be able to tolerate oral magnesium and the high level of bicarbonate she needs in order to get off IV electrolyte fluids all together. I suspect Ashtyn will get out of the hospital by Thursday. We will then stay at the Ronald McDonald Apartments, which is different from the Ronald McDonald House. The apartments are for BMT patients, isolating them from germs and anyone who could be sick. The day after leaving the hospital we will meet with the outpatient BMT team at Seattle Cancer Care Alliance to talk about the possibility of getting her home before Thanksgiving. A few things to pray for: 1. That the Adenovirus will stay under control. The level recently jumped from 1700 to 8500. 2. That she’ll need platelet transfusions only 1 to 2 days a week instead of the current 3 to 4 days a week. 3. Her stomach, bowels, and kidneys will heal.
Nurse Practictioner Stephanie
Physician Assistant Deanna
Physical Therapy
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