Tuesday, April 29, 2014

Hyperinsulinism-First 24 Hours

Friday evening (3 days ago) Casey was playing with Aleah when we noticed she looked very tired, lying down and staring off. She then twitched her arms oddly and we tried to get her attention by calling her name and tickling her. Casey picked her up and she was completely limp with her head rolling around, but eyes open (glassy) and respirations normal. Casey handed her to me and we knew something was wrong. At first we planned on an ambulance but realized we could get to Mountain View hospital's ER faster so Casey quickly buckled the carseat base in (had been moved earlier), and I grabbed the diaper bag and milk.

We jumped in the truck and I buckled her in as Casey drove off. By this time she was alert and crying but sleepy. Not knowing what exactly had happened—we suspected a seizure of some sort—I tried to keep her awake by talking to her. I had called 911 so they knew we were coming and quickly took Casey and Aleah back while I gave some quick information. I soon heard Aleah screaming and anxiously went back to find she hated the blood pressure cuff. That was the beginning of her misery. We described what had happened to the staff while they finished getting vitals; normal except for a slight fever. They quickly inserted a catheter to get a clean urine catch, which looked great, and then moved to the IV insertion. By this time I was bawling as was Aleah and we kept trying to give medical history, etc. to the crew. They got the IV inserted on the first try, drew blood, and then I worked on quieting Aleah down while we waited for information. We got her to eat some and she quickly fell asleep.

The first labs came back indicating a possible urinary tract infection and low blood sugar (BS). The doctor explained an infection could lead to low blood sugar as the body is working harder, which could lead to the seizure he also thought she'd had from our description. At this point she ate quite a bit (5 ounces) so they decided to recheck her glucose levels. They were critically low, at 28 mg/dL, so we thought it had to be a mistake. Retest showed 32. They quickly started her on a glucose drip with an 18 mL bolus and suggested more labs and admitting. We got some more labs sent off and found that our insurance wouldn't cover a hospitalization in Payson so we needed to go up to Utah Valley Medical Center in Provo. They waited for the antibiotics to finish and rechecked her BS. It was 91 so they decided we'd be good for the 20 minute drive to Provo. Casey had earlier run to the house to get supplies while the IV was going.

We quickly got to the pediatric ward and they got vitals and then her BS. It was in the low 30s. Assuming it was a mistake they rechecked it to find just a few points difference. Another glucose bolus was administered and the hospitalist pediatrician on call came to talk to us. He suggested she might be producing too much insulin after getting a history but wasn't sure. He said at this point they just needed to keep her BS high enough and keep her stable. She got the glucose in her system and decided that felt great so she kept us up until 2 AM.

 The next morning the new hospitalist pediatrician came in to talk to us about some labs that had been drawn and some more needed. She started consulting with endocrinologists and decided we needed to draw labs when her blood sugar was low. That meant weaning her off the glucose and waiting for her BS to drop. That took most of the day. My parents came down saw how miserable it was for her to get labs drawn (from her head). They started her back on the glucose and was pretty chipper. She appeared stable and responsive to the glucose so I sent Casey home to get some sleep and let the dogs in the house. Once again she stayed up late and I had barely gotten her to sleep when they needed to check the glucose again.