We also started her on ampicillin 100 mg/kg/day and gentamicin 5 mg/kg every 48 hours. We started her fluids at 120 cc/kg/day but by age 24 hours her sodium was 153, potassium 5.4, chloride 118, and bicarbonate18, and the fluids were increased to 170 cc/kg/day. That made her blood sugar go up, though, to 278 so we started an insulin drip at .06 units/kg/hour or 0.3 cc's per hour. When her sodium rose to 156 we had to increase fluids further to 200 cc/kg/day. On the second day we started feeds at 1 cc every 3 hours or 13 cc/kg/day.
The above numbers are not from a real patient but rather a fictional composite of many patients like this. The number of numbers used in neonatology can be daunting. Some medical students and residents rotating through have trouble handling it.
Personally, though, I love the numbers, and they are one reason I went into neonatology. I love the way we can manipulate the baby's sodium levels by the amount of water we give him and the blood gases by changing the ventilator settings. Remember the story problems you used to have to do in elementary school math? Well, I loved those things, and neonatology is like the ultimate story problem.
The challenge, of course, is remembering that these babies are not just a mass of numbers but real human beings. We can get so caught up in adjusting the fluids in a tiny baby like this that it seems almost as much like a physiology experiment as it is care for a live baby. Sometimes I like to go look at the babies, see their fingers and toes and ears. I like to see the moms visiting them and letting the baby's fingers wrap around her finger. I like the numbers because they are part of a human baby, and managing them helps them become larger and better humans.