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CAPD peritonitis--initial presentation as an acute abdomen with a clear peritoneal effluent
Clinical Nephrology
|March 1, 1992
Summary
Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) may initially present with acute abdominal symptoms before effluent cloudiness appears. Early diagnosis requires considering clinical signs alongside evolving fluid characteristics.
Area of Science:
- Nephrology
- Infectious Diseases
- Gastroenterology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a serious complication of CAPD, requiring prompt diagnosis and treatment.
- Standard diagnostic criteria for CAPD peritonitis include peritoneal irritation symptoms, cloudy effluent with elevated white blood cell (WBC) count, and positive culture.
Observation:
- This report details two CAPD patients presenting with acute abdomen symptoms suggestive of surgical emergencies.
- Initial peritoneal effluent was clear, with WBC counts below the diagnostic threshold (80 and 70/microliters).
- Despite clear initial effluent, clinical signs of peritoneal irritation were present, leading to consideration of laparotomy.
Findings:
- Over time (7 and 12 hours), effluent turbidity and WBC counts significantly increased (6,400 and 2,500/microliters, respectively).
- Cultures confirmed peritonitis caused by Staphylococcus aureus and Streptococcus viridans.
- Delayed but definitive diagnosis of peritonitis was established based on evolving effluent characteristics.
Implications:
- Clinical suspicion of peritonitis in CAPD patients should persist even with initially clear effluent.
- The earliest sign of peritonitis may be subtle, preceding significant changes in fluid appearance or cell count.
- This highlights the importance of serial monitoring of peritoneal effluent in CAPD patients with suspected peritonitis.