Key kidney test at 1pm Pacific

On rounds this morning the doctors felt that Riley's condition has generally improved over two days ago but that it's still too early to know if he'll avoid additional surgery and/or a Fontan takedown. His Tenkoff remains high. They've now reduced his albumen replacement to 50% of the Tenkoff volume and given him a dosage of lasix. At 1pm Pacific they'll send an electrolyte test to the lab and look closely at values that indicate proper kidney function, specifically the BUN (blood urea nitrogen) and creatinine. Currently his BUN is high, at 64. With the reduced volumes and diaretics his BUN should go down, indicating that his kidneys are doing their job. If it stays where it is, it's another hint that his lower body isn't responding well to the new Fontan pressures. At that point, he'll likely head into the cath lab where they'll look to see if fenestration is an option. If it's not, we're back to Fontan takedown as the primary course of action. (Recall that Riley's surgeon is skeptical that fenestration will work for Riley's anatomy, and he reiterated that this morning.) The cardiologist assured us that everything isn't "hinging" on this test, but it's clearly important and we're keeping our fingers crossed. Best outcome would be a reduction in Tankoff and lowered BUN. If that happens, they'll probably stay the course and give it more time.

Riley has been in and out of light consciousness as they intentionally reduce his comatose state. He has been nodding his head yes (wanted a book) and shaking his head no (no ouchies) although his eyes haven't fully opened.