Mild, Moderate, Severe

Another interesting day - we were eating lunch in the conference room when a Sister (nurse) came by and asked whether Dr. Brown was still in the hospital. We replied that he wasn't, and asked why. She replied "I just wanted him to have a look at a baby in the Gastro unit." and walked away. We both thought for a second, then got up and decided to go see what was going on.

As it turns out, there was a very dehydrated baby there who had acutely decompensated. As we worked on helping the intern with assessment, resuscitation, and reassessment, it was hard not to notice that he was the picture of severe dehydration - it was as though he'd read the textbook. He was obtunded - lying with eyes half-open and not responding even to multiple IV attempts, with skin that stayed in an unnatural ridge long after you pinched it. His hands and feet were cold, and his nailbeds took 4-5 seconds to return to their usual pink color after we'd pressed on them. He was grunting, and had thready pulses which were initially only palpable very centrally. His heart rate had gotten as low as 60 when we first arrived.

The amazing and somewhat scary part was that this child had been doing reasonably well just a few hours prior, when he was seen by the team on morning rounds. Then his diarrhea had increased in frequency and volume, he began vomiting, and the volume loss exceeded his capacity for compensation. As we've heard time and time again - kids are resilient. They'll keep on compensating until they absolutely can't. He had reached that point.

I can't tell you for certain if the diarrhea and vomiting had given him electrolyte imbalances or an acidosis; there was no blood gas or istat to help us assess his situation acutely. We sent off labs once he had stabilized a bit, but we'll be lucky to see the results even tomorrow; when I called for his admission labs, which had been drawn two days prior, I was informed that there were never any labs drawn on that patient. Were they drawn but not sent? Lost at the lab? Mislabeled? We'll never know. I had the lab lady search for his results 4 different ways, none of which proved fruitful.

The baby got transferred to the High-Care unit, where he will get closer monitoring. We'll see how he does. He might pull through, or he might be one of the kids who "just dies" overnight. Yesterday we'd seen a child nearly as sick who looked quite a bit better today - it's amazing what proper hydration can do. Maybe today's baby will be as lucky.