Crazy. Week.

Ok, so I know I haven't written since Wednesday, but in my defense - this week has been hellacious.

First, we currently have 3 patients on ECMO. THREE. Usually during a normal week, there might be one patient on ECMO treatment. What makes it even more interesting, is that one of the patients had an intentional overdose on an extended release calcium channel blocker. What this means is that since she took 30 of these pills, they're taking forever to filter out of her system. She's not only on ECMO, but also CRRT. As far as nutrition goes, she's being pumped with 960 grams of dextrose every day. As a normal person, we consume anywhere from 200-300g/day. From research, it seems as though calcium channel blocker medications, when taken in excessive amounts, has a hypoglycemic effect (makes blood glucose very low). So while we're pumping her full of dextrose (another word for sugar/glucose), her blood glucose levels are still low! Not to mention she's on TPN, which means we have to match the sodium as well, so she's getting over about 560mEq. This is like eating a diet that has 13,000mg of sodium per day!!

So, needless to say, I chose this patient for my written case study. But, overall this week I have been exposed to more disease states than I ever imagined. I'm still in an ICU setting, but whereas last week was with one specific patient population with cardiac (heart) issues, this week and next week are just catch-all as far as disease states. We've had 2 intentional overdoses, liver transplant, hypoxia, renal failure, polycystic kidney disease, diabetic ketoacidosis, severe bladder infections, CRRT, ECMO, Steven-Johnson's syndrome, San Filippo-A, sickle cell anemia, and many more. If you're looking for something to do, looking those up on the internet will definitely give you something to do.

Something that I do wish I learned more of in undergraduate work is writing TPN's. I really can't recall even being introduced to what TPN was, well, past what the acronym stands for (total parenteral nutrition). It's such a huge topic and has so many parameters and it does take a long time to get a grasp on, so I do understand why it's not focused on too much in undergrad, as it would take a lot of time to cover. Maybe that's an idea for another class, is a class based solely on TPN. But, just a thought...

Since Wednesday was crazy as it was, I just ended up going home and relaxing, free of internet use. But last night, I went to a presentation compliments of Nutricia. And I say compliments because it was at a super fancy restaurant where they had filet mignon and cabernet wine for dinner, all free of charge. It was a presentation that wasn't required by the internship or anything, but it was advertised for RD's and interns and it helped that it was in the same town I'm living in. The presentation was on "Nutrition in eosinophilic esophagitis (EoE)" The only downfall was that it was so late at night and I ended up taking my (super delicious) blueberry cheesecake to go.

But luckily the weekend is here, and I look forward to relaxing and not having any pre-rotation homework to do, as I'll be in the same PICU rotation next week.

Peace. Love. Internship.