Tuesday, June 18, 2013

Acid Trip......

The preliminary results on Babygirl's bloodwork on Monday showed a fairly unhappy kidney and a recurrence of her neutropenia.  Her creatinine is 1.2, up from 0.9.  Her neutrophil count is just over 900.  Both of these things are of considerable concern and have no real explanation.  But more than that, Babygirl is retaining acid.

Acid-base balance is one of the major functions of your kidneys.  The human body operates in a very narrow pH range, prefering to rest at 7.4.  At a slighltly more acid pH of 7.1 catastrophic stuff starts to happen.  Acid buildup is one of the reasons people with severe infections die - acid is produced by the infective agent (and as a result of damage from the infection) at a rate beyond which the kidneys can clear it.  It messes up cardiac function, liver function, brain function and, of course, kidney function.  But in Babygirl's case the cause of the acid buildup is not something exogenous like an infection, but her endogenous kidney function (or lack thereof).  She is producing a normal amount of acid (we assume) but her kidney is falling behind on cleanup, or getting rid of too much of something else needed to maintain balance.

The easy solution is to give her a base (in this case, some bicarbonate) to counteract the acid.  It's a simple solution, but it doesn't get to the heart of why her kidney has decided to retain acid in the first place.  She had this problem for a short while after the transplant and it righted itself after a month or so of bicarb.  They are waiting until after today's team meeting to let me know whether or not they want do do this.

I personally do not have a really good grip on how bad this is or what it means.  Since it already happened once and resolved, I'm not getting too worked up about it.  Yet.

The neutropenia is another issue.  There really is no particularly good reason for it, since most of the medications that cause this have been discontinued.  Babygirl was complaining of a sore throat for a day or two before her visit, and some viruses can cause neutropenia, so they are doing a recheck on Thursday morning, along with a repeat on her creatinine to see if the whole thing is just a viral blip instead of a trend.

Fortunately for us it was Dr. A who was on yesterday morning.  She's a bit more laid back, worries less, and tends to give things time to develop.  She even told us that some of Babygirl's dietary precautions can be eased if her neutrophil count comes up a bit!  I think Dr. B could have considered admitting us.

Babygirl feels fine.  And she looks fine.  So it's a good day.


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