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bimalc last won the day on September 26

bimalc had the most liked content!

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About bimalc

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  • Birthday 10/09/1982

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    Children's Hospital of Pittsburgh
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    Pittsburgh, PA

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  1. This is so important, not just for development for for the water loss. People think isolettes are magic, but every time we open them we cause water loss.
  2. We have staff dedicated to reviewing charts, running a checklist for every patient as they approach discharge and rounding with the medical team to call attention to items on the discharge checklist that need attention and to give the medical team an opportunity to highlight 'unusual' discharge needs. For emerging follow-up indications which our institution has not formally added to the discharge planner's checklist (for example, currently we do not have formal guidelines for follow-up in nephrology clinic as we just recently hired our first neonatal nephrologist, but we try to flag babie
  3. If you are asking about enteral supplementation for the 'normal' hyponatremia that ELBWs get after the initial diuresis is complete, our goal is to correct this over a week, though often it takes us 2 weeks to get it right. We follow electrolytes and increase dosing every 2-3 days, paying at least as much attention to the chloride as the Na (we occasionally need to do a mix of NaCl and NaHCO3)
  4. You can, in the sense that it is physically possible, however this is likely not advisable as the volumes involved are too large. 0.9% NaCl is 154mEq/L. 1mEq Na = 1mmol. 1mmol Na/kg = ~6.5mL/kg. Over the course of a day 4mmol/kg/d is ~25mL/kg/d. By way of comparison, our local liquid NaCl preparation is 2.5mEq/mL so 4mmol/kg/d is <2mL/kg/d. My advice is that if NaCl tablets are not available in your country but you have a pharmacy capable, see if you can source NaCl powder. 146g NaCl plus QS sterile water to 1000mL final volume will give you a bulk solution of the appropriate con
  5. No electrolytes (except possible Ca) in the first day or so, introduce modest amounts of Na and K in IVF/PN on day 2 or 3 based on diuresis and serum Na level. Closer monitoring is required in ELBW/EPT infants. In my experience in the early going the biggest problem people get into is giving too much free water as opposed to being off on the amount or timing of Na administration. After a couple of days the biggest problem, especially in ELBWs, is that massive amounts of acetate given in TPN to compensate for the normal RTA are not adjusted quickly enough and people overshoot and end up with
  6. At my new institution, we have fixed ratio "K-cocktail" available during codes with (I believe) Insulin, glucose, calcium and bicarbonate. I can get the exact concentrations/doses on Monday when I am back in the unit if you'd like.
  7. I trained using Rocuronium for intubation and during GA for bedside OR cases. When the hospital trying to conserve roc we used vecuronium as a muscle relaxer for intubated patients who needed it. At my current institution, we use succinylcholine for non-emergent intubation and vecuronium if continued paralysis is required.
  8. Can you clarify if you are referring to premature infants with intact bowel or post-surgical short gut/intestinal failure patients? Your options/goals are somewhat different in each setting.
  9. 1-4 ug/kg/h infusions, usually the lower end of that spectrum, titrating by 0.5 to 1 to effect. Obviously respiratory depression is an issue, but these drips are almost exclusively used in intubated patients so less of a concern. Less uniform practice in my group, historically have used methadone or morphine to come off high dose infusions, but we're increasingly using dexmedetomidine for much the same reason/effect as @frvg666 uses clonidine when coming off larger exposures.
  10. Would you care to elaborate? I found your comment the most interesting one aside from the actual clinical narrative that is
  11. Difficult to say without the rest of the relevant parameters on both the vent and the baby, but one has to ask why you aren't on CPAP at that point.
  12. With the humble acknowledgement that I have no idea what the state of clinical informatics is in your work environment, I have to wonder if the use case(s) you envision are not available natively or with some minimal repurposing within your electronic medical record. Depending on the amount of turn over on your unit, the risks of missing patients coming on or off teams may be significant when using auxiliary information systems not tied to hospital census. There may also be significant risks to data security and privacy breaches if you're operating what amounts to a shadow medical record.
  13. Are you able to elaborate on the chest CT and/or share images? I find it quite hard to fathom how a CXR showed total white out at the same time that a chest CT was completely normal. Also, more clinical information would be helpful: blood gases, response to surfactant, vent settings, etc.
  14. Regarding your first question, if you're going to use raw Cr values, please remember that early Cr reflects mother more than baby and that protein malnutrition causes SCr based measures of renal function to over estimate function. In practice I find the various measures used in the AWAKEN studies to be more useful: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933049/
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