Next to Last Call Night at Kijabe Hospital

Saturday, the 2nd of October:

On Saturday, I arrived to round on pediatrics and in the nursery.  I was saddened to learn that, during the night, the baby with the encephalocele who was just extubated on Friday was unable to respire adequately and passed away.  Although this was not a surprise, it was still difficult to hear.  I can't imagine the sorrow that parents experience when they lose a child.

On pediatric rounds we found that the child with extreme cholestasis had begun to improve.  This was an answer to prayer because I did not have much to offer this child in the way of medical treatment.  The child with the huge encephalocele had begun to develop erosions on the encephalocele.  These erosions were being treated, but I doubted that topical or systemic antibiotics would do much good.  The cure for these erosions would have to be surgical removal of the encephalocele, but surgery was apparently not ready to take her to the OR.  I could only hope and pray that they would take her to surgery before the erosions caused sepsis and, ultimately, death.

The other notable event on Saturday was that a child with diabetes had been admitted the night before with severe hypoglycemia.  As this was treated during the night, the blood sugars began to rise and she needed to be restarted on her maintenance insulin regimen.  This regimen was ordered correctly by the intern, but the nurse, being unfamiliar with insulin administration, gave the child 24 units of regular insulin instead of 24 units of 70/30 insulin.  That was a HUGE dose of regular insulin for a pretty small child (4 years old if I remember correctly).  Regular insulin is fast-acting and its effects last a few hours; 70/30 insulin is a combination of regular insulin and long-acting insulin. The net result of this error is that the child received over 3 times as much regular insulin as she should have.  Because this error put the child at risk for severe blood sugar problems and seizures, we had to admit the child to the ICU.  Blood sugars would have to be followed very frequently until they stabilized, which meant I would be called with blood sugars very frequently for the rest of the weekend.  The calls aren't so bad during the day, but you just can't get decent rest when you are awakened every couple of hours.

Just a few more days until our time at Kijabe would be over.  Hoping for no more deaths before we leave.