Page 10 of Holiday Haven

“Okay.” She pulled up Denny’s chart to enter the order. “Anything else?”

“Not at the moment.” There was a slight pause before he added, “Krista? Keep a close eye on him. If Denny really has DKA as a one-month-old then he has a very serious underlying illness.”

She'd heard of cases where young infants had severe acidosis to the point where they suffered a cardiac arrest and died. But she'd never taken care of a patient like that herself. “Maybe we should transfer him to the PICU.”

“I'm in clinic and only have one more patient to see. As soon as I'm finished here, I'll head over. Draw the blood and we'll take it from there.”

He was right, there was no need to panic yet. But she was still nervous as she hung up the phone. With a hurried step she returned to Denny's room to help Wendy. By the time she'd gotten Denny's blood drawn, the baby had become her patient by default. The rest of the second shift nurses had made out the patient assignments, giving her only two babies for now, Joy and Denny, leaving her open for the first admission.

Both were Adam’s patients. What were the odds? For six months she hadn't taken care of any of his patients—now she had the only two patients of his on the entire floor.

Thank heavens Joy was doing fairly well at the moment. Krista knew Denny would need most of her attention. Wendy gave her a quick report, explaining how Denny's mother had gone home to arrange childcare for an older sibling. Krista was very afraid Denny would end up in the PICU before the poor woman could return.

“Krista, the lab is on line one.”

She picked up the phone. “This is Krista Vaughan.”

“We have a critical bicarbonate level on Denny Gibson. His bicarb is 9.0.”

“Really? 9.0?” She repeated the value as she logged into the computer. She knew a bicarb of 9.0 was a dangerously low level. Denny definitely had severe acidosis. “Why don't you give me the rest of the lab results too?”

The lab tech ran down the rest of the basic chemistry results. As soon as Krista finished, she typed the results into a page that she sent directly to Adam.

Her phone rang a second later. “I'm on my way in, “Adam said. “I asked one of my partners to cover my last patient for me. Thanks for sending me the labs. I saw the critical bicarb value and the significant anion gap.” He paused then added, “Stop all Denny's feedings until further notice. I want you to start bicarb drip and check his urine for ketones.”

“I understand.” Using a scrap piece of paper she wrote everything down, worried she'd forget something important. She wanted to ask what he meant by the anion gap, but there wasn't time.

Adam arrived less than ten minutes later. “How is he?”

“Denny tested positive for ketones in his urine.” She stepped aside so Adam could log into the bedside computer. “What underlying disease do you think he has?”

“Propionic acidosis, which is also known as propionyl CoA carboxylase deficiency,” he answered absently, reviewing all the lab results.

She had no idea what that was, but it sounded serious. She made a mental note to look it up when she had more time. “What exactly should I be looking for, other than acidosis?”

He glanced at her, his expression grim. “Signs of central nervous system depression for one thing, sepsis for another. I should have gotten an ammonia level too.”

“I can have that added on to the previous basic chemistry panel we drew,” she assured him.

“Thanks. If it's as high as I think it is, we're going to need to transfer Denny to the pediatric ICU.”

She made the call to the lab as Adam continued to examine the baby. His serious expression concerned her. He almost looked sick to his stomach.

“This disease, this propionic acidosis, what sort of prognosis are we looking at?”

“Pretty bad,” Adam admitted. “With this illness, Denny's body is unable to metabolize certain proteins and amino acids normally. It's a hereditary disease, passed along through recessive genes.” His troubled gaze met hers. “I've never seen a patient survive.”

She sucked in a quick breath. “Oh no. His poor mother.”

“Yeah.” He sighed and dragged his hands down his face. “I need to talk to her as soon as possible.”

She did not envy him that task. “She should be back any minute. I can stay with you while you talk with her.”

“Thanks.” He straightened and examined the baby again. He double checked as if to make sure for himself that she had the bicarbonate infusion going.

Feeling horribly helpless, she stared down at the sweetly innocent baby with the devastating disease. She couldn't even imagine how it would feel to lose a child so young.

Losing her own parents had been bad, but she felt that losing a child must be worse. Much, much worse.

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