Tuesday, December 10, 2002

there's another surgeon here and the renal team just came in. henry has acute tubular necrosis which is a kidney disorder involving damage to the renal tubule cells, resulting in acute kidney failure. everyone feels he is "so far behind" that we really need to get the dialysis going right away. surgery is scheduled for late this afternoon. laurie is getting the crown fixed on her tooth and then will be back. we made an appointment for jack to see one of the child-family life specialists on the floor later today.

they came in to do an ultrasound a little while ago and the technician asked, "where is henry's kidney." that happens every single time they do an abdomenal ultrasound. henry's kidney is a pelvic or ectopic kidney and it is very far down. once they thought he was born with only one 'cause they coudn't find it.

we sit right next to the ventilator and it puff puff puffs away 24/7. it sounds like a small steam locomotive. the little engine that could. henry's gotta make it over that hill.

joe, as i explained earlier, is a great eater and probably doing the best of all of us. he is thriving, taking his first real steps right outside of henry's hospital room. henry's room is at the very end of the hallway. here is a photo taken in the "lounge" area that is just outside our room. the windows overlook the big muddy, which is plenty big, but not too muddy up this far north. it is a spectacular view and we get nice sunsets over the river. for some reason i really like driving across the mississippi all of the time. once, when we were here last spring, jack and i walked down to the river from the hospital and skipped rocks. very huck finn moment. most of the rooms on the unit are big with a bunch of babies in incubators or cribs under warmers. it is almost like henry is the senior resident here. one little girl down the hall was in surgery for 28 hours over the past 2 days for her heart. amazing. i almost forget about henry's stay at boston children's when he was just 6 mos old getting his heart fixed.

i was looking up acute tubular necrosis and it was linked to this page on medline about septic shock. it is a good overview of why we are here. it says that you have a 50-50 chance of surviving, and frankly, those are better odd than we've had for a lot of other stuff we've been through, though this is the worst thing ever to happen to henry, by far. the real wild card remains the infection. they still haven't cracked that nut. nothing has "grown out" of the cultures they've taken.


Septic shock is a serious, abnormal condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. Vital organs, such as the brain, heart, kidneys, and liver may not function properly or may fail. Decreased urine output from kidney failure may be one manifestation.

Causes and risks

Septic shock occurs most often in the very old and the very young. It also occurs in people with underlying illnesses. Any bacterial organism can cause septic shock. Fungi and (rarely) viruses may also cause this condition. Toxins released by the bacteria or fungus may cause direct tissue damage, and may lead to low blood pressure and/or poor organ function. These toxins also produce a vigorous inflammatory response from the body which contributes to septic shock.

Risk factors include underlying illnesses, such as diabetes; hematologic cancers (lymphoma or leukemia); and other malignancies and diseases of the genitourinary system, liver or biliary system, and intestinal system. Other risk factors are recent infection, prolonged antibiotic therapy, and having had a recent surgical or medical procedure.

Prompt treatment of infections caused by bacteria is helpful. However, many cases cannot be prevented.


Fever, chills
Feeling light-headed
Shortness of breath
Cool, pale extremities
Elevated temperature
Restlessness, agitation, lethargy, or confusion
Some physical findings may be easily detected:

Rapid heart rate
Low blood pressure, especially when standing
Low urine output

Signs and tests

Blood gases may reveal low oxygen concentration and acidosis
Blood cultures to detect infection
Blood pressure readings are low
Chest X-ray may reveal pneumonia or pulmonary edema
The blood count may reflect infection
Blood tests may reflect poor organ function or organ failure


Septic shock is a medical emergency, and patients are usually admitted to intensive care.

The objective of treatment is to:

Provide oxygen, and treat respiratory distress if present
Administer intravenous fluids to restore blood volume, and vasoactive drugs to treat low blood pressure
Treat underlying infections with antibiotics
Support any poorly functioning organs
Hemodynamic monitoring, to evaluate the pressures in the heart and lungs in treatment of shock, may be required. This can only be done with specialized equipment and intensive care nursing.


Septic shock has a high death rate, exceeding 50%, depending on the type of organism causing the infection and the degree of organ failure.


Respiratory failure, cardiac failure, or any other organ failure can occur.