Jasmine Stalker-Firth

Jasmine’s sodium bicarbonate levels have been high for a while. This means that her body pH levels are higher than the normal healthy range of 7.35-7.45 and so her body fluids are too alkali. The doctors think that this could be because Jasmine has been vomiting too much with being ill and so has lost a lot of stomach acid. This leaves the rest of the body out of balance. It is better to be too alkali than too acidic though.

Another issue is that we have swapped to the two chamber dialysis bags. Single chamber bags are glucose based, which is acidic on the peritoneal membrane, and may cause damage over the long term. The two chamber system has a chamber of glucose and a chamber of bicarbonate, and you have to break a seal to mix the bags while setting up the machine. This gives a bio-compatible mixture at the same pH as the body.

However, using the two chamber bags on pediatric patients can lead to alkalosis. The first thing we tried was changing the dialysis program from 11 dwells over 12 and a half hours. Jasmine now has nine dwells of one hour over 12 hours. We have saved another 30 minutes, which is great, but we are a bit worried about the bicarbonate to fully appreciate it at the moment. Jasmine has been for U&Es (blood tests for urea and electrolytes) twice, and though the bicarbonate levels have come down slightly they are still too high.

The next thing to try is to reduce the vomiting. We have been trying to do that since Jasmine was born though. We are going to reduce the amount of fluids we give her and give them more frequently. Otherwise we may have to go back to the naso-gastric (NG) tube again. Jasmine has been feeding without it for 20 weeks now, which is unheard of. She is the only baby on dialysis at Great Ormond Street without an NG tube or gastrostomy. Jasmine vomited all the time with the NG tube though, so I don’t expect it to improve much. We may try feeding her from a bottle, rather than the cup, and see whether that makes it easier to spread the feeds out.

This entry was posted on Monday, April 27th, 2009 at 5:27 pm and is filed under home. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.