No improvements

The milrinone was stopped last night. It is a medicine that helps the heart relax and fill properly. The idea was that removing it would help his blood pressure increase into a more healthy range. It worked for a bit, but his blood pressure fell into the high 60s/ low 70s again this morning.

Also, the damage to his kidneys and liver has not shown any improvements. While it's good that they are not getting worse, the residual impact of a build-up of a variety of toxins does make him in overall worse shape. Doctors are considering putting him on dialysis for a bit to remove some of the toxins from his blood. He was also low on calcium, so he's been given some of that.

Riley is also positive more than two liters of fluid. For most people when you drink two liters of fluid most of that comes out as urine, sweat, etc., but for him, very little is coming out. The result is that he's quite swollen. We're seeing it in his face, eyelids, feet, hands, and belly, although it's really everywhere. An ultrasound of his stomach showed that a bunch of fluid is collecting around his stomach and it's estimated that he has 100-200 mls of fluid in there. A pigtail drain will likely be put in to drain that fluid. There is concern that the build up of fluid there will prevent his organs from getting enough blood and oxygen flow. The mindset is that if there is anything visible that they can improve, they are going to do it since his body is struggling so much.

The blood pressure was the main topic of discussion at rounds. Even though he is so swollen with fluid, they need to give him more to boost his blood pressure. Given his Glenn circulation, they need to make sure that he can properly perfuse his brain and low blood pressure can affect how much blood and oxygen gets in there. This is of critical importance.

He will continue to be fully sedated, paralyzed, and on the ventilator for the foreseeable future.