GUILTY NY - Garnett Spears, 5, dies of salt poisoning, Chestnut Ridge, 23 Jan 2014

[TupeloMz]

Pediatrician testifies no medical explanation for Garnett's sodium level to spike from 144 to 182 in 5 hours #laceyspears trial

Last tweet from Lee Higgins about an hour ago.

 

[ScarlettScarpetta]

http://radaronline.com/exclusives/2015/02/mommy-blogger-trial-video-reveals-lethal-salt-injection/

That is just horrible. That poor poor baby.

 

[ScarlettScarpetta]

Wanted to add another point- I see now she's been claiming he wouldn't hold food down. Well, if that truly was the case,besides acid blockers, they could've tried to prescribe anti-nausea meds like Zofran. It's just NOT standard procedure to give a 1 mo. old a feeding tube for GERD, no matter how hard Lacey tries to spin it!!! I heard the latest claim is that they're trying to say maybe he had diabetes or Addison's disease, neither of which there is a basis for in his case!!:doh::maddening:

P.S. I'll be following this trial and not Aaron Hernandez's.

I think that the Dr's bear some responsibility here also. It seems that she led Garnetts procedures. And that is crazy!

 

[K_Z]

Pediatrician testifies no medical explanation for Garnett's sodium level to spike from 144 to 182 in 5 hours #laceyspears trial

Last tweet from Lee Higgins about an hour ago.

182? Omg.

That's the first actual Na+ level I've read connected with this case. I had wondered just how high it was. And now I wish I could convey the nauseating, "pit of my stomach" feeling I have just reading the number 182. I wish there were some way to transfer that sickening feeling to the jurors, for whom this number is probably just a "number." I just hope and pray that there is some way that the prosecutors can try to impress on them how serious and how awful that number really is, and what it means. That poor child.

Thank you very much to all who posted updates for today-- I was out of pocket much of the day.

ETA: Going to try to find a few references to illustrate just why I feel so nauseated when faced with the 182 number. It's just outrageous.

http://adc.bmj.com/content/68/4/448.full.pdf

The quantity of salt needed to cause a specific
level of hypernatraemia can be calculated as
follows:
If an infant weighing 10 kg has a serum sodium
of 216 mmol/l, that represents an excess of (216-
140)=76 mmol/l. A 10 kg infant has approximately
6 litres of water of which 2 5 litres is
extracellular fluid. Therefore the excess sodium
is represented by 76x2- 5 =190 mmol; 190 mmol
of sodium is contained in (190/17)=11 g of salt
(just under two teaspoons full).
The usual urine sodium potassium ratio is 2-8
(range 1 4-5-2). The usual urine sodium:
creatinine ratio is 39.
Gastric aspirate usually contains 50-60
mmol/I of sodium. If concentrations of over 200
mmol/l are identified, it is highly suggestive that
salt has been ingested.

Ok, so I assumed a 50 pound child, and did my own calculations with this formula.

If I did all my calculations right for an approximately 50 pound child, given 2300mg Na+ per tsp of table salt, the rapid spike in Na+ could have been produced by about 2-3 tsp of salt dissolved in a small amount of water or some liquid, given at once rapidly via g-tube, with no additional liquid to dilute. (Ok, I am not an expert, just an anesthesia formula wonk, using this formula, and other formulas for total intra/ extracellular body fluids in a child, along with known amounts of sodium per tsp of table salt.)

http://en.wikipedia.org/wiki/Hypernatremia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095029/

http://www.azcentral.com/story/news...accused-of-poisoning-child-with-salt/7554925/

More articles from today:

http://www.cbsnews.com/news/lacey-spears-trial-did-a-suburban-mom-kill-her-five-year-old-boy/

http://www.lohud.com/story/news/cri...ears-trial-rockland-nurse-testifies/23354687/

Dr. Sarika Sunku who treated Garnett on Jan. 19, 2014, said 182 is "very high" for a child and prompted the hospital to seek a second round of blood tests at the advice Westchester Medical Center staff. About an hour later, his sodium level was 178, she said.

"It basically shrinks the brain and can cause brain damage," she said. "We basically start to get worried once it reaches 150."

While providing Garnett's medical history, Spears also told Sunku that he was admitted into intensive care as a baby with a sodium level of 200. Sunku testified that such a high level would have left him with severe brain damage or killed him.

 

[Harmony 2]

Old article:

The newspaper obtained a copy of Garnett's child fatality report in New York that revealed the medical records showed that there was concern for Lacey Spears' "emotional stability and it was presumed she suffered from Postpartum Depression and Munchausen Syndrome by Proxy."

http://www.usatoday.com/story/news/nation/2015/01/15/lacey-spears-trial-munchausen/21817517/

If Munchausen by Proxy was suspected, in the medical records, why wasn't anything done? Why isn't it being used as a motive during the trial?

 

[K_Z]

Old article:



http://www.usatoday.com/story/news/nation/2015/01/15/lacey-spears-trial-munchausen/21817517/

If Munchausen by Proxy was suspected, in the medical records, why wasn't anything done? Why isn't it being used as a motive during the trial?

Because MBPS is not a "diminished capacity" mental defense.

If the defense seeks a formal diagnosis of MBPS, they essentially end up with an admission of guilt, AND the inability to use it as a mental health defense. And if the prosecution uses the term, without a formal diagnosis, the jury is confused as to whether the person is really mentally ill, and not responsible for their actions, and should be found "not guilty". MBPS is an Axis II disorder, considered to be a personality disorder (not diminished capacity like Axis I disorders, like schizophrenia).

MBPS focuses on the "poor mom", not the "poor victim". The newest trend by prosecutors appears to be to avoid that label, and instead focus on the evidence of what was actually done to the child (Medical Child Abuse), as well as the consciousness of guilt when they take measures to conceal or cover up what they do to to the child (as when Lacey called the neighbor and asked her to dispose of the feeding tube bag with the high concentration of salt in it). Rather than focusing on the "motivation" for why they did what they did, and wandering around in the "weeds." Whether or not these women "need" psych/ mental health care is immaterial at trial-- lots and lots of killers are competent to stand trial, but have odd or impulsive or premeditated motives as to why they killed someone.

Interestingly, many prosecutors have gone for 2nd degree charges, which are easier to prove, than risking the "all or nothing" premeditation issues with first degree murder charges. I think prosecutors think 2nd degree cases will be easier to explain to the jury. And often the sentencing is not that much different (unless they seek death, which is a whole new ball game.)

Colloquially, everyone calls these cases "MBPS", but many attorneys seem to feel that is not a diagnosis to be sought during the run up to trial, and can't be used if not formally diagnosed.

Here is an interesting discussion by a Texas prosecutor who has successfully prosecuted a few of these cases in recent years.

http://www.tdcaa.com/node/2871

Oh-- and the "MBPS" in the medical records, if documented, can't be used, since the medical records belong to the child. The diagnosis would apply to the mother, not the child, and without evidence of formal diagnosis, means nothing. It's a way to explain what is going on, but the newer, more formal term in Child Abuse Pediatrics is "Medical Child Abuse".

Here's a powerpoint presentation:

http://pediatrics.uchicago.edu/chiefs/CPS/documents/AAPMunchausen.pdf

Confusion

§ Who gets the diagnosis?
§ Mother/caregiver?
§ Child?

§ Who makes the diagnosis?
§ Primary care physician?
§ Child abuse pediatrician?
§ Psychiatrist?

 

[borndem]

182? Omg.

That's the first actual Na+ level I've read connected with this case. I had wondered just how high it was. And now I wish I could convey the nauseating, "pit of my stomach" feeling I have just reading the number 182. I wish there were some way to transfer that sickening feeling to the jurors, for whom this number is probably just a "number." I just hope and pray that there is some way that the prosecutors can try to impress on them how serious and how awful that number really is, and what it means. That poor child.

Thank you very much to all who posted updates for today-- I was out of pocket much of the day.

ETA: Going to try to find a few references to illustrate just why I feel so nauseated when faced with the 182 number. It's just outrageous.

http://adc.bmj.com/content/68/4/448.full.pdf



Ok, so I assumed a 50 pound child, and did my own calculations with this formula.

If I did all my calculations right for an approximately 50 pound child, given 2300mg Na+ per tsp of table salt, the rapid spike in Na+ could have been produced by about 2-3 tsp of salt dissolved in a small amount of water or some liquid, given at once rapidly via g-tube, with no additional liquid to dilute. (Ok, I am not an expert, just an anesthesia formula wonk, using this formula, and other formulas for total intra/ extracellular body fluids in a child, along with known amounts of sodium per tsp of table salt.)

http://en.wikipedia.org/wiki/Hypernatremia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095029/

http://www.azcentral.com/story/news...accused-of-poisoning-child-with-salt/7554925/

More articles from today:

http://www.cbsnews.com/news/lacey-spears-trial-did-a-suburban-mom-kill-her-five-year-old-boy/

http://www.lohud.com/story/news/cri...ears-trial-rockland-nurse-testifies/23354687/

Thank you, K_C, for the articles and for your medical comments. I welcome them and I look forward to your posts.

 

[seattlechiquita]

Thanks everyone for the updates. Been crazy at work and haven't had much time to clean my house (not that I miss doing THAT, but I miss y'all).

 

[K_Z]

Lacey Spears' murder trial resumes Tuesday with the eighth day of testimony. A doctor who treated Spears' son at Nyack Hospital days before he died is due back on the stand Tuesday.

Courts are closed Monday for Presidents' Day. The trial opened Feb. 3.

http://www.lohud.com/story/news/crime/2015/02/15/lacey-spears-murder-trial-synopsis/23455149/

 

[kimi_SFC]

http://www.lohud.com/story/news/crime/2015/02/15/lacey-spears-murder-trial-synopsis/23455149/

:tyou: K_Z! This link is excellent. If you scroll down to the lower portion of the article, there are links to embedded videos where you can watch the following (I'm mobile, so I apologize for not being able to attach the actual links here :blushing: ) :


Earlier stories:
Day 7: Doctor cites salt levels; nurse describes boy's worsening condition
Day 6: Doctor says boy had no seizures
Day 5efense cites video edits
Day 4: Prosecution video shows boy retching, in pain
Day 3: Defense portrays Lacey as caring mom
Day 2: Defense: Garnett may have had diabetes
Day 1 (opening statements): Lacey Spears a 'calculating child killer,' prosecutor says

#JusticeForGarnett

:rose:


Sent from my iPhone using Tapatalk

 

[K_Z]

Ramapo police Detective Gregory Dunn testified Tuesday that he seized an open container of sea salt that was sitting on the kitchen table in front of a photograph of Garnett Spears when investigators searched Lacey Spears' apartment in Chestnut Ridge on Jan. 22, 2014.

Dunn also seized an open container of Himalayan salt from the apartment and found two more unopened containers of salt there eight days later, after Garnett had died and Spears had vacated the home, he said at the woman's murder trial in Westchester County court.

Earlier Tuesday, Dr. Sarika Sunku, a pediatrician who treated Garnett at Nyack Hospital, testified that, when she told Lacey Spears the night of Jan. 19, 2014, the results of bloodwork showing the boy's sodium level surged, "She just had a smile on her face."

Garnett had been trying to vomit that day, but a medical procedure he had as a baby prevented him from doing so, Sunku testified.

"He was retching so badly," she said.

http://www.lohud.com/story/news/crime/2015/02/17/lacey-spears-murder-trial-continues/23550505/

My BBM-- smiling?? Sadistic.

(KZ note on second BBM- the doc may be referring to a nissen fudoplication surgery, in her comments about Garnett being unable to vomit. This procedure is done for serious cases of stomach reflux, where the stomach is sort of snugged up and wrapped around the lower esophageal junction.)

http://en.wikipedia.org/wiki/Nissen_fundoplication

Vomiting is often impossible or, if not, very painful after a fundoplication. In some cases, the purpose of this operation is to correct excessive vomiting. However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely with some amount of pain.

 

[K_Z]

LoHud article updated at 6:44 this eve.

Garnett Spears was "healthy and happy" and "jumping off the bed, running around the floor" at Nyack Hospital on Jan. 18, 2014, just five days before his death, a friend of the boy's mother testified at her murder trial Tuesday.

Danielle Grossenbacher, who had befriended Lacey Spears at a Chestnut Ridge retreat four months earlier, said it was a different Garnett she encountered the next day at the hospital.

"When I walked into the room Garnett was on the bed with hospital staff around him," Grossenbacher said during the eighth day of testimony at Spears' trial. "His body was flailing all over the bed and he was unresponsive."

Grossenbacher said Lacey Spears appeared "scared" but "seemed a little withdrawn" during the episode.

"I did not see her cry," she said.

The trial resumes at 2 p.m. Wednesday.

http://www.lohud.com/story/news/crime/2015/02/17/lacey-spears-murder-trial-continues/23550505/

 

[ScarlettScarpetta]

LoHud article updated at 6:44 this eve.





http://www.lohud.com/story/news/crime/2015/02/17/lacey-spears-murder-trial-continues/23550505/

So she poisoned him again and maybe she knew she had gone too far?! GAh, This poor child.

 

[borndem]

Original quote from me, borndem:

Thank you, K_C, for the articles and for your medical comments. I welcome them and I look forward to your posts.

K_Z - Please excuse me misspelling your name on here yesterday -- I know better, I really do.

My original thanks was certainly no misspelling at all!!

(I will write K_Z, K_Z, K_Z fifty more times on the blackboard!)

 

[mamaleena]

Thank you so much for the snippets, I keep hitting a paywall when I go to the lohud site. This poor baby, he may have been able to vomit up the salt if he hadn't had that procedure.


Sent from my iPhone using Tapatalk

 

[K_Z]

K_Z - Please excuse me misspelling your name on here yesterday -- I know better, I really do.

My original thanks was certainly no misspelling at all!!

(I will write K_Z, K_Z, K_Z fifty more times on the blackboard!)

Oh my- you can stop with the blackboard, lol! Think nothing more of it! We all have tpyos. (But feel free to leave out the underscore from time to time. I look so much thinner, and more glamorous, that way!) :blowkiss:

 

[K_Z]

When Dr. Ivan Darenkov suggested Garnett Spears go under general anesthesia for a biopsy to determine whether the 5-year-old had celiac disease, the boy's mother agreed.

But when the pediatrician repeatedly recommended a nutritional and feeding evaluation that might have led to the removal of a feeding tube in the boy's stomach, Lacey Spears didn't appear as responsive, Darenkov testified Wednesday afternoon at Spears' murder trial in White Plains.

"Did she ever follow up?" prosecutor Patricia Murphy asked.

"No," Darenkov replied.

But prosecutors implied Spears likely wouldn't have followed up, because for months, the pediatrician, who saw Garnett five times from April through November, repeated the same recommendation, but with no reaction from Spears.

"If not every time we had a visit or discussion, then almost every time, I recommended a feeding and nutritional evaluation."

A feeding evaluation would have required five specialists examine how well Garnett ate in a hospital setting, while a nutritional evaluation would have required days of counting calories to make sure he was eating enough food.

http://www.lohud.com/story/news/crime/2015/02/18/lacey-spears-murder-trial-day-nine/23631005/

Article says the biopsy was done for celiac disease, and was negative. Article also quotes the family doc who saw Garnett over several months, and recommended a feeding and nutritional eval (to see if the g-tube was still necessary) at every appointment. Both docs stated Lacey was resistant/ ignored discussions about evaluating Garnett to see if the g-tube was still needed.

(We talked about this months ago on this thread, that if the g-tube had been placed at age 9 months, and given his vigor, that docs would have repeatedly recommended a feeding and nutrition eval. And now we know that the docs who saw him did recommend this, even with the patchwork of care he received when they moved to several different states.)

Earlier version of this article from 4 pm or so says yesterday defense and prosecution argued in court (outside of jury's hearing) about whether or not jury would see a demo of the feeding tube and bags/ pump. Apparently the decision was the jury could see the demo, which was shown in court today (by the prosecution, I think).

Tomorrow:

On Thursday, Ramapo police Sgt. John Lynch is scheduled to testify about Web pages officials say Spears visited and read, which prosecutors say was in preparation of poisoning her son.

Additional comments in the article state that the defense objects strongly to Sgt. Lynch testifying, and the judge will make a decision in the morning.

 

[K_Z]

http://www.lohud.com/story/news/crime/2015/02/19/lacey-spears-trial-day-ten/23672353/

The lawyer asked if the doctor's opinon would have changed if the information on the Nyack chart was shown to be unreliable, but Goltzman wouldn't confirm that, saying hospital personnel would have had to give Garnett three-quarters of a bag of saline with an unusually high 3 percent concentration to get the spike in salt that Garnett had.

"That mathematics doesn't make sense to you?" Riebling asked him.

"No," Gotlzman replied.

But defense lawyer Stephen Riebling argued that the seizing of the empty water bottle held little significance because Garnett's salt levels when he "coded" were exactly what Goltzman had expected.

The doctor had ordered a slow drop in sodium levels for Garnett because, while high amounts were life-threatening, a quick drop was equally dangerous due to possible complications, such as seizures. Goltzman testified that he was concerned Garnett would be given too much water as much as he was of high sodium levels. But tests confirmed salt levels were about right.

KZ note: Red BBM. Doesn't make sense to me, either. Nyack would never have given GS any 3% hypertonic saline, and regular normal saline wouldn't produce the 182 level, even if he got a whole bag IV by mistake.

3% hypertonic saline comes in 500cc bags (not liter bags), and has extremely limited and highly specific applications for specialized intravenous use, such as in severe brain injury. It's really hard to tell from the news articles what was going on medically at each specific point in time at Nyack and Maria Fareri, and whether GS had more than one high sodium spike during his time at each hospital. It certainly makes sense that they were trying to gradually bring down his high levels at Maria Fareri (perhaps the one high level prior to transfer from Nyack), to prevent sudden brain swelling, following his crisis and transfer there. That requires precise control of free water and salt administration.

GS would not have been on IV hypertonic saline before the ICU code, with his serum Na+ levels already so high (also, hypertonic saline has to be administered via central IV line, not peripheral). It's much more likely he was on just a little IV fluid of D5W or half normal, to slowly dilute out his high sodium over many hours. Remember, he was awake and alert at that point.

His newly drawn ICU code lab value that showed the Na+ level diluted out and too close too quickly to the normal range (this is what the defense attorney picked apart in his opening statement-- that the Na+ level was "normal" during the last code, so Lacey didn't poison him). Especially if Lacey reported GS drank 1000cc of water. The defense attorney appears to have picked at something in the chart to suggest GS received too much IV saline of some variety-- I think he's blaming Nyack for giving him too much saline and causing the high Na+ level. GS most likey never received any hypertonic saline at all at either hospital, and the doc was just commenting what would have occurred "if" he got 3/4 of a bag of hypertonic saline. (This is really hard to reconstruct from the LoHud article, but I think that's what he was saying. He was using an extreme example of an accidental hypertonic saline bolus to produce the high Na+ value. The defense attorney must have found an error in the Nyack chart-- maybe a check box in the electronic record not checked correctly, or something. He's introducing doubt, and shifting blame to the Nyack staff.)

Info on IV saline:

Intravenous saline solutions that are commercially prepared come in "normal saline" (which is 0.9% nacl), "half normal", and "quarter normal" (0.45%, and 0.225%). Half normal and quarter normal are "less salty" (hypotonic) than normal body fluids. Normal saline is roughly "the same" as body fluids.

http://en.wikipedia.org/wiki/Saline_(medicine)

Here' a protocol for the use of hypertonic saline, for acute brain injury, and critically low Na+:

http://www.vchca.org/docs/hospitals/hypertonic-saline-practice-guideline-4-2011.pdf?sfvrsn=0

Based on how Garnett's salt levels spiked from 144 to 182 in a matter of a few hours while at Nyack Hospital right before he was transferred to Westchester, the boy would have had to ingest the equivalent of five bottles of salt water, Goltzman testified. The doctor said he was suspicious that Garnett would have voluntarily drank that amount, particularly because his mother also had said he'd drunk 100ccs of regular bottled water, which equates to more than six bottles.

"It's a lot of water for me to drink, let alone a 5-year-old," Goltzman testified. "It's hard for me to believe."

Red BBM-- this is clearly a typo in the article. 100cc is about 3 1/2 ounces. I believe they inadvertently left off a zero, and the number was intended to be 1000cc. (1000cc is about a quart, or one standard IV bag). The "five bottles of salt water" comment is also puzzling-- is he referring to the naturally occurring concentration of salt in the water, versus someone deliberately concentrating salt water? (I wonder if that was transcribed accurately.)

I'm gonna try to interpret the medicalese here.

The doc is suspicious that LS was giving plain water via the g-tube while in the Maria Fareri ICU, while they were intravenously trying to gradually bring down the high level, with precise titration of IV and oral water restriction, to keep his brain from swelling. From what I can glean here, things were going well with that process in the ICU at Maria Fareri, and rather suddenly GS coded with blown pupils and herniation by CT. That could indicate a rapid introduction of too much free water.

The defense seems to be trying to suggest GS was on IV saline (or even normal saline, or half normal) and inadvertently got too much all at once (either at Nyack or Maria Fareri). The doc is saying whatever the labs showed at the time of this second code at Maria Fareri, didn't match up mathematically (with the newly drawn labs from the code) with a rapid bolus of intravenous saline back at Nyack, that it would have had to be 3/4 bag of hypertonic saline given back at Nyack to achieve that original set of labs (using this as an extreme example). That's my best guess, given the little bit of info in the article. They are going back and forth with what happened at Nyack, versus what happened at Maria Fareri, so it's hard to keep the conversation straight from the article.

Ramapo police Sgt. John Lynch was scheduled to testify about Web pages officials say Spears visited and read, which prosecutors say was in preparation of poisoning her son. But, due to vigorous objection by defense lawyers, prosecutors agreed to preview Lynch's testimony in front of the judge and lawyers for them to decide whether he can testify before the jury.

 

[LinasK]

http://www.lohud.com/story/news/crime/2015/02/19/lacey-spears-trial-day-ten/23672353/






KZ note: Red BBM. Doesn't make sense to me, either. Nyack would never have given GS any 3% hypertonic saline, and regular normal saline wouldn't produce the 182 level, even if he got a whole bag IV by mistake.

3% hypertonic saline comes in 500cc bags (not liter bags), and has extremely limited and highly specific applications for specialized intravenous use, such as in severe brain injury. It's really hard to tell from the news articles what was going on medically at each specific point in time at Nyack and Maria Fareri, and whether GS had more than one high sodium spike during his time at each hospital. It certainly makes sense that they were trying to gradually bring down his high levels at Maria Fareri (perhaps the one high level prior to transfer from Nyack), to prevent sudden brain swelling, following his crisis and transfer there. That requires precise control of free water and salt administration.

GS would not have been on IV hypertonic saline before the ICU code, with his serum Na+ levels already so high (also, hypertonic saline has to be administered via central IV line, not peripheral). It's much more likely he was on just a little IV fluid of D5W or half normal, to slowly dilute out his high sodium over many hours. Remember, he was awake and alert at that point.

His newly drawn ICU code lab value that showed the Na+ level diluted out and too close too quickly to the normal range (this is what the defense attorney picked apart in his opening statement-- that the Na+ level was "normal" during the last code, so Lacey didn't poison him). Especially if Lacey reported GS drank 1000cc of water. The defense attorney appears to have picked at something in the chart to suggest GS received too much IV saline of some variety-- I think he's blaming Nyack for giving him too much saline and causing the high Na+ level. GS most likey never received any hypertonic saline at all at either hospital, and the doc was just commenting what would have occurred "if" he got 3/4 of a bag of hypertonic saline. (This is really hard to reconstruct from the LoHud article, but I think that's what he was saying. He was using an extreme example of an accidental hypertonic saline bolus to produce the high Na+ value. The defense attorney must have found an error in the Nyack chart-- maybe a check box in the electronic record not checked correctly, or something. He's introducing doubt, and shifting blame to the Nyack staff.)

Info on IV saline:

Intravenous saline solutions that are commercially prepared come in "normal saline" (which is 0.9% nacl), "half normal", and "quarter normal" (0.45%, and 0.225%). Half normal and quarter normal are "less salty" (hypotonic) than normal body fluids. Normal saline is roughly "the same" as body fluids.

http://en.wikipedia.org/wiki/Saline_(medicine)

Here' a protocol for the use of hypertonic saline, for acute brain injury, and critically low Na+:

http://www.vchca.org/docs/hospitals/hypertonic-saline-practice-guideline-4-2011.pdf?sfvrsn=0



Red BBM-- this is clearly a typo in the article. 100cc is about 3 1/2 ounces. I believe they inadvertently left off a zero, and the number was intended to be 1000cc. (1000cc is about a quart, or one standard IV bag). The "five bottles of salt water" comment is also puzzling-- is he referring to the naturally occurring concentration of salt in the water, versus someone deliberately concentrating salt water? (I wonder if that was transcribed accurately.)

I'm gonna try to interpret the medicalese here.

The doc is suspicious that LS was giving plain water via the g-tube while in the Maria Fareri ICU, while they were intravenously trying to gradually bring down the high level, with precise titration of IV and oral water restriction, to keep his brain from swelling. From what I can glean here, things were going well with that process in the ICU at Maria Fareri, and rather suddenly GS coded with blown pupils and herniation by CT. That could indicate a rapid introduction of too much free water.

The defense seems to be trying to suggest GS was on IV saline (or even normal saline, or half normal) and inadvertently got too much all at once (either at Nyack or Maria Fareri). The doc is saying whatever the labs showed at the time of this second code at Maria Fareri, didn't match up mathematically (with the newly drawn labs from the code) with a rapid bolus of intravenous saline back at Nyack, that it would have had to be 3/4 bag of hypertonic saline given back at Nyack to achieve that original set of labs (using this as an extreme example). That's my best guess, given the little bit of info in the article. They are going back and forth with what happened at Nyack, versus what happened at Maria Fareri, so it's hard to keep the conversation straight from the article.

So if I understand you right- her Defense Team is trying to blame to death on the hospital???

 

[ScarlettScarpetta]

So if I understand you right- her Defense Team is trying to blame to death on the hospital???

That is impossible. The Saline bags are metered and are not enough to kill you. Not even if you got the whole thing fast.
This is called grasping for straws.