"Sweet" hydrothorax complicating chronic peritoneal dialysis

Area of Science:

• Nephrology
• Pulmonology
• Diabetology

Background:

• Massive pleural effusion is a rare but serious complication of peritoneal dialysis (PD).
• Patients with end-stage renal disease (ESRD) and diabetes are particularly vulnerable to PD complications.
• Uncontrolled hyperglycemia can exacerbate respiratory distress and fluid imbalances.

Purpose of the Study:

• To report a case of massive pleural effusion during PD in a patient with type 2 diabetic ESRD.
• To highlight the diagnostic challenges and management of this rare complication.
• To emphasize the importance of considering PD-related complications in patients with new-onset respiratory symptoms.

Main Methods:

• Case report of a patient with type 2 diabetic ESRD undergoing PD.
• Clinical observation of new-onset dyspnea, right pleural effusion, and hyperglycemia.
• Analysis of pleural fluid characteristics (high glucose content).
• Management involved discontinuation of PD and initiation of hemodialysis.

Main Results:

• The patient developed significant respiratory distress and a large right pleural effusion.
• Pleural fluid analysis revealed a high glucose concentration, consistent with dialysate leakage.
• Discontinuation of PD and transition to hemodialysis led to rapid improvement in respiratory status and glycemic control.

Conclusions:

• Massive pleural effusion can be a life-threatening complication of PD, particularly in diabetic ESRD patients.
• Prompt recognition of dialysate leakage into the pleural space is crucial for effective management.
• Hemodialysis may be a necessary alternative treatment modality for such patients.