When Jasmine was taken off the dialysis machine this morning she had a cloudy drainage bag. This can indicate peritonitis, which is an infection of the peritonium. The nurse took a sample and sent it off for analysis. Jasmine didn’t have a temperature though, which can be a sign of peritonitis too. The initial tests showed a white count of 15, too low for peritonitis. Later on in the afternoon some more results came back, indicating that the cloudiness was caused by lipids. Apparently these are leaking from her lymphatic system. The lipids have been identified as chyle. The doctors think that maybe the peritoneal dialysis (PD) catheter has poked or scraped something and caused this breakage. It is an extremely rare complication of PD, but the few reported cases have cleared up without further difficulties.
The long-chain fats in breast milk and SMA are seeping through the lymphatic system and into her peritonium, making her fluid cloudy. To give this breakage a chance to heal, Jasmine is being put on medium-chain fats in the form of Monogen. (Ruth: Monogen smells and tastes like potato starch, I would throw it up too.) She will also be on Liquigen and Vitapro. Given a few weeks, the damage should heal and Jasmine can return to drinking breast milk.
Jasmine was much more sick than usual, for reasons that are not clear. It may be related to the excess chyle in her peritonium. The nurses on the night shift will drain her peritonium tonight. She threw up three times during her 3pm feed and was quite distressed. She threw up her NG tube too and so the nurse had to put a new one into give her half of her 6pm feed, which she didn’t want and threw it up. Her blood pressure was also all over the place between 60 and 140.
Just to keep us busy the doctor said that he is taking Jasmine off dialysis. Apparently her creatinine levels have decreased faster than is possible with dialysis alone. Therefore, he suspects that the function of the right kidney has improved somewhat. This sounds like fantastic news, but we have to not get our hopes up. Her creatinine levels are still 10 times higher than they should be. Jasmine is not going on dialysis tonight, so the nurse locked off the line with heparin (an anti-coagulant) to stop it clogging up. They are going to monitor her bloods and see how she does. Hopefully her head won’t swell up to the size of a wagon wheel this time.