Caring for critically ill kids

"The numerous deaths in the recent gastroenteritis outbreak in Tondo, Manila might have been avoided if the victims have been brought right away to the hospital."

Thus, observed Dr. Herbert Uy, a balikbayan physician under the Department of Science and Technology’s Balik Scientist program in 1998, and is now the section chief of St. Luke’s Medical Center’s Pediatrics Intensive Care Unit, a relatively new innovation in hospital care.

Whether one calls it an Intensive Care Unit (ICU) or Critical Care Unit (CCU), patients referred to this particularly specialized unit need closer monitoring, and sometimes are in shock or on the brink of death.

It also provides physical and emotional relief for members of the family who have to take care of the patients knowing that a specialized unit is in existence. In SLMC’s Pediatric CCU, the ratio is one patient to one nurse.

As in the gastroenteritis outbreak, the only time the disease can kill an individual, especially a child, is when the patient gets severely dehydrated or there is an abnormally low level of salt in the body. Once this occurs, hydration or intake of fluids should not be delayed.

When the kid is brought to the Critical Care Unit, intravenous fluids are immediately given. If the veins are too small, central lines are placed for more stable delivery.

The body functions at a certain salt concentration, and Uy cautioned that giving plain water (which has no salt) excessively may lead to electrolyte imbalance. He urged that the term fluids be used and given instead. That include juices, soup, oral rehydration solution and milk.

Other Pediatric CCU Cases

What are the other cases normally brought to the Pediatric CCU?

Aside from those coming from the ER and those coming from surgery, children suffering from blood pressure problems and medically referred to as having hemodynamic instability are brought to the Pediatric Intensive Care Unit (PICU).

Depending on the age, a 10-year-old can have the same blood pressure as an adult which can be from 110/70 or 120/80, while a younger one can have 80/40 to 90/50. Children are also susceptible to low blood pressure or uncontrolled hypertension due to various conditions like kidney problems coming from scoliosis surgery.

Another reason for admission is that the child’s platelet count has dropped as in the case of dengue patients. Once thought of as a rainy day disease, dengue is now happening all year round. Uy said it seems in the Philippines, there is a rise in the number of cases every three years.

The normal platelet count is 150,000/mm. If the count goes down to 100,000 or even falls below 50,000, medical help should be sought right away. If it is already in the 20,000 to 30,000 level, there might be internal bleeding in the stomach and other parts of the body.

Uy urged that parents should bring their sick children right away to the nearest hospital once they see the following: any form of bleeding, not eating anymore and vomiting of digested blood. Do not wait for the child to reach the shock stage where he gets to be incoherent, in between consciousness (goes in and out), does not recognize family members and is not responsive anymore.

The balikbayan doctor noted that taking care of sick children is a big challenge. To be able to bring them back to their former state of well-being is a welcome payoff. Looking on the bright side, Uy had seen kids to be more resilient compared to adults in combating illnesses. Bouncing back to normalcy is a lot easier for them.

For more information, call the Endocrine, Metabolic and Diabetes Center at 723-0101 local 5210.

(Dr. Herbert Uy had his residency and fellowship at the Children’s Hospital of Michigan, Wayne State University. He has published several articles here and abroad on caring for critically ill children).