Hypokalemia is not a term I was familiar with until this last week. Hypokalemia is low levels of potassium. I don’t know if I ever mentioned that I was able to switch Colby’s formula in August from Compleat Pediatric a lovely formula that is supposed to be made from real food but is actually made up of mostly corn syrup to a new formula call Liquid Hope that is made of real food with no crazy additives and words you can’t spell let alone say. I was thrilled Tricare was going to pay for this as it’s pretty expensive. What does that have to do with potassium levels?
It appears that Hypokalemia occurs when there is not enough potassium in your diet but can also occur with large levels of vomiting. Colby vomits daily. Yes, daily. Somedays it’s only once or twice, most days around 5:00 he starts throwing up every ten to fifteen seconds until I give him his meds to go to sleep. That’s two hours of throwing up every night. He gets no food by mouth or even in his G tube so he’s basically throwing up stomach acid, then bile, then blood. Good times right? His GI doctor has said for the last seven years that he is to spastic for a nissen and she wouldn’t recommend it. The last time Colby saw her she changed her mind and decided he was now a candidate. We’ve been resisting the idea of getting a nissen for a long time but I think that we’ve finally reached the point where we need to have it done.
Back to the food issue. Compleat Pediatric has less potassium in it that Liquid Hope does. It is not natural potassium though so it is more bioavailable than natural potassium is. Weird right? I think it is. The combination of vomiting and switching from a synthetic potassium to a natural potassium caused Colby’s potassium levels to drop drastically within a month. It started on Monday when we went back to the doctor for what we thought was pneumonia that wasn’t clearing up. The doctor ordered a chest x ray and blood tests. The x ray was clear. No sign of any pneumonia at all. At any time in the last two weeks! Now we needed to wait for his blood tests. His CBC came back normal but thankfully the doctor also ordered a metabolic panel. Wow were his electrolytes screwed up. Low sodium, low potassium. Fun stuff. He wanted me to take him back for another blood test that night and possibly be admitted to the hospital that night.
We went back and got more labs drawn. His levels came up .1 so the doctor felt that we could go home and run him on pedialyte all night and see if that brought his levels up to a more acceptable level. We did that and then went back for more labs the next morning. This time his levels dropped .5. Now he was in the dangerously low levels. He earned himself an admit to the local hospital. I took him in with a bag of stuff for overnight. The doctor ordered an EKG that showed he was going to be having heart problems quickly if this problem wasn’t corrected fast. John felt like it would be best for Colby to go down to the children’s hospital so after discussing it with pediatrician I agreed that’s where we should go.
It all sounds pretty straight forward but I was seriously stressing out. John was upset over the whole situation. I was upset that he was upset. I was stressed because so far other than high blood pressure we haven’t dealt with cardiac issues. I wasn’t home to get the girls to where they needed to go. John couldn’t find the stuff I needed him to pack. Let’s just say that by the time the ambulance crew was there to take us I was in full breakdown mode. Colby’s doctor handled my tears well. The two EMT’s were very patient while I tried to get everything straight and settled. It’s not often I break down but when I do it tends to happen at really inopportune times!
I got Colby his medicine and I figured he’d have a very nice comfortable trip down to the hospital. I on the other hand forgot that lately I’ve been getting motion sick in the car. Not cool when you are sitting sideways in the back of a very bumpy ambulance. I was worried about Colby throwing up instead I was the lucky winner of the throwing up contest. Tears, throwing up and being incredibly tired do not make me very happy camper.
I think we got down there around 9:00 at night. The nurse got him hooked up to the monitors fairly quickly but did not put in an i.v.. About an hour later the resident came in to get his history. The really crazy part of the whole puzzle was that he had a fever of 101 degrees every day for the last two weeks. Fever is not typical with hypokalemia. He was also having stridor and an increased need for oxygen. The resident went and got the attending physician who was also stumped. They decided to go discuss things with the entire team and said they’d get back to us. Around midnight it was decided that he would go get another chest x ray to see if Monday’s x ray had missed something and he would also get an x ray of his esophagus. I watched the images as they came up on the screen. The chest x rays looked the same but I was shocked when I saw the one of his esophagus. There was clearly a narrowing of his esophagus. I didn’t know what it meant but I knew it was why he was having stridor.
I’m able to access Colby’s medical records online so I saw the radiologists read of his x ray before the doctors came back. Turns out Colby had croup the last two weeks. He doesn’t cough on his own so I never heard the bark. I’m quite familiar with croup. Jahnna had it a lot and my brothers also had it when they were younger. It never once crossed my mind that is what Colby had going on. Finally around 2:00 in the morning the resident came back and said that they were going to give Colby some potassium into his feeding tube and they were going to order a consult with the ENT department in the morning.
The rest of the night went by in a blur. Three lab draws, vitals, all the usual fun of a hospital stay. I didn’t get much sleep but thankfully John got some. The next day Colby’s potassium had risen dramatically from dangerously low to the high side of normal. Crazy how fast it works. His heart rate slowed to normal levels, his EKG was normal, he was starting to breath easier. We waited for the ENT doctors to show up and they finally did. Basically they want to do a bronchoscope the next time he has anesthesia. Colby has been intubated over forty times in the last seven years and they feel that there might be scar tissue causing some of the narrowing. The croup had inflamed his esophagus to much to do it while he was there. They want to wait six weeks and then do the procedure. The ENT also said that based on his history he would recommend a nissen as soon as possible.
Colby was discharged late Wednesday night and we made it home around 1:00 in the morning. It was a very long three days that capped off a very long two weeks of trying to figure out what was going on with him. I now have to give him potassium and sodium supplements daily to keep his levels at the correct levels. He will have a follow up blood draw tomorrow and hopefully it will remain at a good level and things can calm down a little bit around here. That was our fun week, how was yours?