...Sashy is definitely acting like someone who's never seen a bathroom before. Huh. Even if she's literally from a third world country, Marian isn't sure how you could be in Canada for more than a few hours without using a toilet. Maybe if she and her probably-relative-of-some-kind lived in their car or something? 

She'll lead Sashy over to the sink and show her how to run the tap. 

Tsashi jumps in surprise, then lights up. The big building doesn't just have daylight inside, it has a tiny magic river that goes and stops for you! Magic from before the Cataclysm is wonderful! Why did Lionstar never tell her– ...that's a stupid question, of course it would make him sad to talk about it. 

...She's actually very thirsty. She isn't sure if she's supposed to touch the river, but she'll move slowly so that Merrayne can stop her if it's dangerous. She cautiously sticks both hands in the river and, when this doesn't get her slapped or pulled away, cups her hands to fill them and then bends over to drink. 

Oh nooooooo Marian feels terrible now for not offering her something to drink sooner! ...Also Sashy's hands are filthy. The blanket is now sliding half off her shoulders to reveal a...short dress? Long shirt? of some noticeably coarse-threaded weave, and also deeply impregnated with dust. 

"No, no." She turns the tap off. "Sorry. I'll get you water." She tries to mime holding the shape of a cup. "Here -" She pulls down wads of paper towel and shows Sashy how to dry her hands. Really it seems like a good idea to get her to wash them properly, if she's going to be wandering around 'Lionstar's' hospital room touching things, but that can wait until after Sashy is hydrated. And doesn't actually have to be in the bathroom, the ICU rooms have sinks, though she should probably detour back here anyway to show Sashy how to use a toilet. Oh god is she going to have to demonstrate peeing on it. Conveniently she does have to pee kind of badly at this point

Once Sashy's hands are dry, and hopefully at least slightly cleaner, Marian ushers her out of the bathroom and around the corner to the little patient kitchen, which has a stack of paper cups and a water and ice dispenser. 

Tsashi did not at all follow why she's supposed to drink out of this magic river instead of that magic river, but she makes a note of it anyway! Cups make sense, at least, though it's mysterious what these ones are made of. She gulps down a cup of water and copies Marian to refill it and gulps it down again. 

And from there it's another five minutes or so of awkward puttering back and forth, to show Sashy how to use a toilet (she looks awed at the concept, and then pees in front of Marian with zero self-consciousness) and how to use soap to wash her hands (she stares at the foam like it's literal magic) and then over to the clean utility room to get a fresh blanket out of the warmer. (Sashy seems reluctant to let go of her old blanket, and instead folds it up neatly and carries it with her, which Marian is fine with.) 

It would be nice to get her washed up more thoroughly and wearing something cleaner - maybe some of the smallest-size OR scrubs would do in a pinch - but that sounds like a longer project, and Marian is antsy about leaving Nellie to do all the work with her patient for too long. They'll do a final stop at the kitchen so she can show Sashy the contents of the fridge and offer her some graham crackers and, on consideration, a cup of the Resource 2.0 liquid meal supplement. Marian got a slightly better look at her while they were switching blankets, and it seems likely she could really use the calories. 

Aaaaaand back to the room, where hopefully someone else has caused a comfortable reclining chair station to exist? 

Someone has! 

Nellie also immediately turns to fix a beady gaze on Marian. She points at the monitor, which now has a temperature tracing, because Nellie thought ahead and used the Foley catheter with an indwelling core temperature probe. 

"Did you know your patient's temp was 31.9 C?" 

"Gah! I - no - I mean, yeah, he was hypothermic when he came in, but we had the Bair Hugger on him, I can't believe he dropped nearly an entire degree!" ...Where did the Bair Hugger go. Oops, it definitely looks like they took it off him to deal with the soiled linens and then left it behind in the ER. 

"Ah. Well, he's got no body fat and he's not shivering - OP toxicity causes muscle weakness, he might be partially paralyzed - so he can't be producing much body heat. Oy! Louis-Philipe! Grab us a Bair Hugger, would you? I think there's still one more in the clean utility, if someone else took it since I last looked then I guess go steal it from the ER..." 

There are raised voices! Tsashi is pretty sure they aren't being raised at her but if anything it's more alarming for them to be raised about, presumably, Lionstar's injuries. 

Tsashi will just try to stay very out of the way? 

Oh no she scared the kid. Reassuring smile reassuring smile probably that's not very reassuring ugh. There are too many things wrong with this patient and it feels unfair. 

"Dr Sharma thought he probably needed more fluids." Marian peers at the urine in the collection bag. There's already 400 ccs in it, pale straw-color. Cold diuresis, maybe...does cholinergic stimulation increase urine output, something feels familiar about that... "Uh, we can give that heated once she orders it -" 

Louis-Philipe shoves the ICU Bair Hugger machine, fresh blanket balanced on top, the rest of the way to the door. "Lab's calling for you, Marian. Line 6. Critical results." 

Of fucking course. "Uh, thanks - Nellie, I should go take that -" 

What are these critical results spoken of? 

Critically low magnesium at 1.0 mg/dL (normal range 1.8 to 2.6). Critically low phosphate at 1.2 mg/dL (normal range 2.5 to 4.5). Critically low potassium at 2.8 mmol/L (normal range 3.5 to 5.2). 

Critically high lactate at 9.2 mmol/L (normal range less than 2), though this isn't all that surprising, it was drawn when they were practically in the middle of coding him. 

Critically, terrifyingly low venous blood glucose, all the way down at 39 mg/dL (normal range of 72 to 108.) 

Moderately but not critically low albumin. Maybe he's a bit protein-deficient. 

Everything else is within normal parameters! 

Yikes! So much yikes! This patient has way too many serious problems and should share some of them with the rest of the unit

...For one, Marian has no idea what's up with the glucose. If it was an expected consequence of the poisoning then Nellie would have said something. Two, the diarrhea and sweating and general exodus of bodily fluids would explain some electrolyte imbalance, but surely not this bad this fast. ...The lactate is genuinely probably a lot better now that he's had a tolerable blood pressure for the last while, they should redo that. 

The glucose might be an error somehow. Probably not, Marian has a feeling it's real, but it's quick to check. She thanks the lab tech and hangs up the phone and runs for the med room to grab a glucometer. 

"Nellie! Check his blood sugar - lab called said it was 39 - I'm gonna go tell Dr Sharma and get dextrose -" 

Conference room, right. She runs. 

The shouting and running is really alarming! Tsashi wants to know what's happening, but it seems like it would be a bad time to ask even if she knew how and could understand the answer. 

She doesn't want to touch Lionstar in case it messes something up or gets her yelled at, but she glues herself as close to the magical artifact supporting his body as she can. 

Dr Sharma is perched on a chair on the conference room, legs tucked under her, cell phone cupped to her ear and apparently listening to someone on the other end of the line; she's scribbling furiously on a legal pad. 

She sees Marian, makes a 'wait one second' hand gesture, writes another note, then cups her hand over the phone. "Hmm?" 

"Um. Labs are back. Critical results on potassium, mag, and phos – uh, low, I didn't write down exactly what, but really low. Lactate high but that's not weird. Blood sugar is really scary low, Nellie's rechecking it but on the labs it was, like, under 40?" 

"One sec." Dr Sharma brings the phone to her ear again. "Hey - sorry, I'll be right with you in a minute - we got some results back, electrolyte imbalance - yeah, K is low - one sec -" To Marian again, "- was it under 3?" 

She should have written things doooooooooown. "Um. I think so–" come on Marian's brain, you heard the number less than a minute ago "- yeah, it was 2.8." 

"Shit. Okay. That's a bad sign, we'll want to supplement ASAP - it sounds like there's not much benefited to giving the activated charcoal, and he isn't vomiting, so let's try 40 mEQ by gastric tube, that's faster. If he vomits we'll try IV. And we want his magnesium high, let's give him 4mg over an hour and reassess from there." 

Pause. 

"...You said low sugar? Bizarre, that's not– eh. If the bedside glucometer confirms it, give him an amp of D50 and recheck. I'll be over in five minutes, I need to finish here." 

...Nod. "Um, I think we're still waiting on X-ray for the tube, and then we'll need you to confirm it -" 

"Yeah. I'll be over really soon. - oh, you can go ahead and try 6 mg atropine now. Nellie's right, we're not going high enough, we want to be reassessing every 5-10 minutes and doubling the dose if it's not effective yet." 

"Uh, okay." That is NOT HOW DRUG DOSING WORKS. Marian wonders if the Pyxis even lets you take that much out at once. "We'll do that." It won't add anything to say please hurry up and come see him, so she doesn't. "So - start magnesium 4mg, recheck sugar and treat if it's low, atropine, wait on you for the gastric tube?" 

She waits for the confirming nod, and then heads for the med room at a jog. 

The Pyxis wants Marian to confirm several times that she does, in fact, for real, want to take out two (2) 5mg ampoules of atropine, but it lets her override and do this. In contrast, nabbing a premixed 4mg bag of magnesium and 40 mEQ oral potassium elixir are straightforward. The 50ml giant syringes of 50% dextrose can be nabbed off a shelf. 

She's going to grab a bag of IV potassium too, it's not like the guy isn't already having GI symptoms. It feels to her like it's a thing for very sick patients to have a hard time with enteral potassium even if they weren't vomiting before they got it. 

What else - ugh she didn't get an order for more fluids, she really should have asked about that - she'll grab a new bag of saline anyway for later microwaving in the patient kitchen. Syringes and needles for mixing should be in the room, she had time to refill that drawer. She stuffs her scrub pockets with a handful of IV tubing - mag could go in a piggyback on the saline, except no nevermind it's on gravity tubing, they'll want another IV pump...

She heads back to the room rather than detour to the clean utility for IV pumps, and drops her hoard on one of the bedside tables. "Nellie, we need to give him mag and 6mg atropine. And I've got D50 if he's really low–"