Since the last update resulted in so many questions from Zachary's friends and family, I asked Zachary's Uncle Jeff, who is a practicing internist in LA and monitors Zachary's progress by phone with his doctors every day, to do a better job of explaining what's going on.
Here's how my brother-in-law explains the medical situation:
Management of IV fluids is always challenging in severe illness. In a baby weighing less than 8 pounds, this challenge is monumental. Zachary has lost tremendous amounts of bodily fluids in the diarrhea and vomiting that struck him. He has been kept alive on IV fluids. All of the derangements of electrolytes (sodium and potassium) were caused because ZZ got too dry, in essence, like a potato chip. As a result, his neurological function declined a couple days ago, making him less responsive and making him appear very ill.
When the pediatric nephrologists determined this to be the cause, the only option was to aggressively re-hydrate Zachary. The problem is that such aggressive re-hydration can overwhelm the cardiovascular system. Fluid can then escape into the lungs causing pulmonary edema. If that had occurred, Zachary would’ve been transferred into the NICU and placed on a ventilator for respiratory support. The doctors and nurses were prepared for this but he tolerated the intervention and apparently looked better right away.
He was then placed on “nothing by mouth” status overnight. Despite having nothing to eat or drink for 16 hours, he continued to have copious diarrhea. This is a secretory diarrhea, meaning that the intestines are so inflamed from the initial infection that they are “weeping” fluid (with electrolytes). The best approach is to continue allowing the GI tract to “rest” and to feed Zachary through the vein. While such an approach carries new risks, it is better that continuing to flog the GI system. According the the pediatric GI specialist, the diarrhea could last from 2 days to 2 weeks or longer.
That’s the update from January 4, 2007, submitted by Zachary’s uncle who takes care of grown-ups, not kids, and also submitted from a distance.
Get well Zachary!
Jeffrey A. Hirsch, M.D.
It's frustrating because we still don't know what caused the initial vomiting although something viral is suspected because many many other things have been ruled out through testing. The good news is that this appears to all his doctors to be acute rather than chronic meaning that when he gets better, we are hopeful that he will go back to being a normal healthy kid who just got really sick.
JZ, DZ and zz
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