Wednesday, 26 March 2014

24hr Fluid Challenge

I'm typing this from my bed. I am exhausted, I'm cranky - it's not a pretty picture.
After everything we went through in London I didn't think anything could scare me again...but I was wrong.
You all know Martha has had episodes of vomiting, she's on Ranitidine and Domperidone for it. She has a feed and a few moments later she brings it all up, I get her in new clothes and put her down for a nap and we carry on as though it never happened. I'm used to it by now.
But Monday morning was different. She vomited before she even had a feed for breakfast. This is not like her. I decide to let her drink what she wants from her bottle for breakfast and to give her the rest once I'm back from the school run. It's a struggle but she drinks 20ml, I test her tube and give her meds, then I pop to the kitchen.
I hear her coughing, me and Mark look at each other because we both know what's coming next...right on cue she vomits up her feed and meds.
I get her dressed and we take Osh to school. When we get back I decide to give her some milk down her NG tube so she has something to keep her going, but as I test her tube she vomits some more. I call Mark home from work so we could take her to our local hospital, we were convinced her tube had moved and that's why she was sick.
The nurses suggest we let Martha feed a few mls orally so they're able to test the tube is in the correct position, Martha keeps this down and we take her home. But a couple of hours after arriving home she vomits again - huge amounts... It must not have been her tube.
I call Mark home from work so we can take her back to the Children's ward. The whole time we were there she didn't vomit once. We were told at 4:15 by the SHO that a Senior Doctor would come to see Martha shortly. By 8:50pm we still hadn't seen any one so we put Martha's coat on and make our way out...but we are stopped by a staff Nurse who said we couldn't leave until Martha has been seen. She's finally seen at 9:15pm by a Doctor who suspected a urine infection, but he was happy that she looked "Clinically well" (Mark's going to get that on a T-shirt) so we could take her home; but we were to bring her in straight away if she started vomiting again and they would take a water sample from her.
But she vomited up the midnight feed at home, and also the breakfast feed the next morning. Something wasn't right.
I called the Children's ward and updated them, told them I was worried that she would get dehydrated and that I think she should have IV fluids. A Doctor called me back and said that as Martha was only vomiting and was "clinically well" when he saw her the night before I wasn't to bring her in.
Red rag to a bull. I was furious, he already said he suspected a urine infection and I know how quickly Martha's condition can accelerate...But he wouldn't budge. So I called Great Ormond Street who said they wanted Martha reassessed, the nurse even offered to call Ysbyty Gwynedd for us but I asked her not too because I worry they will be awkward with us the next time we take Martha in.
She suggested we take her to our GP and try Marthq on a 24hr Fluid Challenge with Dioralyte. She calculated that Martha need's 25ml of fluid every hour.
We took her to our GP who was happy that Martha was alert, he noted that Martha was Tachapnoeic but he wasn't aware of her baseline,  I told him she usually takes 55bpm and he agreed there was no increase. However if we weren't getting any wet nappies from Martha we were to call him so he could arrange admission to Ysbyty Gwynedd.
So for the first 3 hours we gave Martha 25ml on the hour every hour, it was then increased to 50ml every two hours, 75ml every three hours and eventually 100ml every 4 hours. If she tolerated that we could slowly introduce Milk.
Luckily it seems to have worked and she hasn't had any vomiting episode's since yesterday morning. At 11am this morning we nervously allowed her to drink 25ml of Milk and put 75ml of Dioralyte down through the NG tube - she must have been starving because she tanked her bottle. She kept that feed and at 3pm we did the same again which so far she has tolerated. Her next feed is due at 7pm and she will have 50ml of Milk and 50ml of Dioralyte.
What was worrying us is that we didn't know why Martha was vomiting... But at 3am this morning we were woken up by a vomiting Isabella Nicole. Mammi has felt rough all day and in the last couple of hours it's also taken Daddy down. So it must have been a bug.
I'm still angry with Ysbyty Gwynedd; no child regardless of their condition should be refused access to medical treatment. Sometimes I really miss the security of Great Ormond Street.
GM
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