19.1.11

COTW: Higher Mathematics

Please forgive the technical and somewhat nerdy nature of this post. If you'd like to pass on it in favor of a story of more casual amusement, click here.

A couple of weeks ago, Tenwek's IVPU went down. The IV Production Unit is a brilliant little onsite operation where we produce our own IV fluids. This apparently lowers costs for patients, enables us to have a steady supply, and also allows us to produce some types of fluids not available on the local markets. It went down, got fixed, and is down again. This is a good example of something you don't value adequately until you don't have it. IV fluids are a simple, but absolutely essential, part of much of the work we do.

So we have been buying fluids from other places and trying in general to not be wasteful of that which we have. However, the NICU (or sick newborn nursery) is one of the places where the IV fluids that we need are only available to us because we make them. In other words, tiny babies require special fluids that are not available for purchase, largely because very few other places do the level of newborn care that we do.

So, the in-charge nurse from the NICU finds me last week:

"Daktari, we are out of D51/4NS."
"Really? Well, we're going to have a hard time taking care of little babies without that."
"Yes."
"What do we have?"
"We have NS, D5W and D10W."
"Hmm..."

I sat down and scrawled out the following:

Now, in the US, you just name your fluid, and you get it. So I have exactly zero practice figuring out this kind of thing. But it seemed intuitive enough, and thankfully I had a very flexible nurse who was willing to try it, despite the fact that mixing all these fluids together makes for a lot of work for them.

And now, we've run out of D10W as well, so I'm not quite sure where we're headed now.

A similar thing happened when my DKA ("very sick diabetes") patient in the ICU needed to be switched from D5NS to D10NS. The nurse asks: "OK, how do you make that?" Umm...

I was hoping to find the answer on Wikipedia, because that sounded cool, but instead I got the basic info I needed from ehow.com, and worked out the rest of the math for myself.

Just another example of the role of creativity in dealing with things we've never encountered before. Even after a year.

Good thing Jess is a math teacher.

3 comments:

Anonymous said...

Impressive, Eric! How did the nurses mix it? Running several pumps at different rates or did they pour it together and then run it as one fluid? We had a lot of malfunctioning equipment at work this week and I was saying how we don't really realize how much we depend on that stuff until it goes awry...what a challenge Tenwek would be!

Sami

The Drs. McLaughlin said...

Tenwek does have a few IV pumps, but you usually only find them in ICU or surgical recovery. These fluids are tediously made by drawing them up from one bottle with a syringe and then transferring them to another bottle. Then administered by counting drips per minute. (at least, I think so)

Eric P said...

Love it! Did you end up making the D10 from D5 by adding some D50?