Treatment peritoneal dialysis

Cornerstones of treatment are dietary restriction of branched-chain amino acids and high dose thiamine, the latter showing responsiveness in cases with mild and/or intermittent presentations. Acute episodes are life threatening and require aggressive treatment peritoneal dialysis may be necessary because renal clearance of the toxic metabolites is poor. ... 

Intraperitoneal (IP) administration of antibiotics is preferred over IV therapy in the treatment of peritonitis that occurs in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The International Society of Peritoneal Dialysis (ISPD) recently revised its guidelines for the diagnosis and pharmacotherapy of peritoneal dialysis (PD)-associated infections.24 The guidelines provide dosing recommendations for intermittent and continuous therapy based on the modality of dialysis [CAPD or automated peritoneal dialysis (APD)] and the extent of the patient s residual renal function. 

Furthermore, pH determination has been used in other clinical research, both alone and in combination with other measurements. This research includes studies into the relationship between extracellular and intracellular pH in an ischemic heart [6, 7], the pH of airway lining fluid in respiratory disease [8], the study of pH as a marker for pyloric stenosis [9], malnutrition in alkalotic peritoneal dialysis patients [10], pH modulation of heterosexual HIV transmission [11, 12], and wound prevention and treatment [13], In addition, pH changes due to blood acidosis have been used to trigger and pace the ventricular rate of an implanted cardiac pacemaker [14], Research using pH measurements... 

Elevated Lp(a) levels were reported in patients with various forms of renal failure and under treatments like hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) (B28, Cll, H5, K2, K5, M34, P4, P6, S8, T2, W8). After renal transplantation and CAPD, Lp(a) concentrations are reported to de-... 

For patients who have ingested more than 30 ml of (pure) methanol or ethylene glycol, dialysis is recommended, and haemodialysis is more effective than peritoneal dialysis. Dialysis both removes the alcohols and their metabolites, and corrects the renal and metabolic disturbances and so is the preferred treatment in severe poisoning. The maintenance dose of ethanol required may be tripled during haemodialysis as ethanol is also removed. Early treatment is indicated if ethylene glycol concentrations are above 20 mg/100 ml (200 mg/1), if the arterial pH is below 7.3, if serum bicarbonate concentrations are less than 20 mM/1, and when there are oxalate crystals in the urine. 

Vancomycin and teicoplanin display excellent activity against staphylococci and streptococci, but because of the wide availability of equally effective and less toxic drugs, they are second-line drugs in the treatment of most infections. As antistaphylococcal agents they are less effective than 3-lactam cephalosporin antibiotics, such as nafciUin and cefazoUn. They have attained much wider use in recent years as a consequence of the emergence of methicUlin-resistant S. aureus (MRSA) infections, in particular the growing importance of Staphylococcus epidermidis infections associated with the use of intravascular catheters and in patients with peritonitis who are on continuous ambulatory peritoneal dialysis. 

Reductions in renal and hepatic function do not alter plasma drug concentrations, and ketoconazole is not removed by hemodialysis or peritoneal dialysis. Penetration into cerebrospinal fluid is negligible, so that ketoconazole is ineffective in the treatment of fungal meningitis. Since only small amounts of active drug appear in the urine, ketoconazole is not effective in the treatment of Candida cystitis. 

The supportive treatment of aspirin poisoning may include gastric lavage (to prevent the further absorption of salicylate), fluid replenishment (to offset the dehydration and oliguria), alcohol and water sponging (to combat the hyperthermia), the administration of vitamin K (to prevent possible hemorrhage), sodium bicarbonate administration (to combat acidosis) and, in extreme cases, peritoneal dialysis and exchange transfusion. 

Hemodialysis (383,552,553), sometimes with additional continuous venovenous hemofiltration dialysis (554,555), continues to be described as a successful intervention for lithium poisoning. Peritoneal dialysis is a far less efficient way to clear lithium from the body. One patient treated in this way had permanent neurological abnormalities and another died a third toxic patient who also had diabetic ketoacidosis died after treatment with hydration and insulin (556). On the other hand, a 51-year-old woman who took 50 slow-release lithium carbonate tablets (450 mg) had a serum lithium concentration of 10.6 mmol/1 13 hours later, but no evidence of neurotoxicity or nephrotoxicity. She was treated conservatively with intravenous fluids and recovered fully (557). Acute lithium overdose is often better tolerated than chronic intoxication. 

Haemodialysis may be indicated after the condition has passed from functional renal failure to true renal insufficiency. Discussion should also centre on dialysis as a possible way to bridge the phase of renal insufficiency or to gain time for the liver function to improve and allow the hepatorenal syndrome to become reversible. (31) Peritoneal dialysis achieved temporary success in treating azotaemia and hyponatraemia, but the lethality rate could not be reduced. Nevertheless, some cases of successful treatment were observed. (48)... 

Di Paolo N, Garosi G, Monad G, Brardi S. Biocompatibility of peritoneal dialysis treatment. Nephrol Dial Transplant 1997 12(Suppl l) 78-83. 

Serious nephrotoxicity is uncommon, but nephrotic syndrome can develop in about 0.3% of patients, generally among those who have experienced mild proteinuria earlier in treatment. Very exceptionally, acute renal insufficiency can occur peritoneal dialysis has been reported to promote recovery. 

Schaefer F, Klaus G, Muller-Wiefel DE, Mehls O. Intermittent versus continuous intraperitoneal glycopep-tide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol 1999 10(l) 136-45. 

Based on a study of 10 patients with automated peritoneal dialysis, it was recommended that for empirical treatment of dialysis-related peritonitis, the dosage of intermittent intraperitoneal tobramycin must be 1.5 mg/ kg for one exchange during the first day and then 0.5 mg/ kg thereafter, to reduce the risk of adverse effects (47). 

Vale JA, Prior JG, O Hare JP, et al. Treatment of ethylene glycol poisoning with peritoneal dialysis. Br Med J (Clin Res Ed). 1982 284 557... 

Sabto JK, Pierce RM, West RH, et al. Hemodialysis, peritoneal dialysis, plasmapheresis and forced diuresis for the treatment of quinine overdose. Clin Nephrol. 1981 16 264-268... 

Initial treatment of the acute kidney injury consists of intravascular volume repletion and restoration of the blood pressure. Treatment with mannitol, alkaliniza-tion of the urine and diuretics have all been tried with variable success [110, 111, 122,127]. Clearly, supportive care and dialytic intervention when necessary are crucial to allow for adequate recovery. Hemodialysis may be more effective than peritoneal dialysis in highly catabolic patients with rhabdomyolysis-induced renal failure. 

Peritoneal dialysis clears only 9-15 mL/min of lithium, and is therefore not recommended for the treatment of acute lithium toxicity [125,126]. Conventional hemodialysis, on the other hand, decreases serum lithium levels at a rate of 1 mEq/L with every 4 hours of treatment [126]. Several treatment sessions of hemodialysis may be required, and serum lithium levels need to be checked frequently even after hemodialysis, because of the shifting of hthium from inside the cells (lithium rebound phenomenon). In those patients who may have ingested the sustained-release form of lithium, continued absorption from the GI tract may cause a rise in serum hthium levels between hemodialysis sessions [128]. 

Acute kidney injury (ARF) was found to be the second life threatening effect. Hemodialysis had been used as a method of treatment with variable success [27-29]. On the other hand, peritoneal dialysis was used in the treatment of the ARF due to PPD toxicity in other reports [39]. 

According to the revised literature there are 88 patients described, 46 previously on hemodialysis (HD), 19 on peritoneal dialysis (PD) and 23 without previous dialytic treatment (supportive treatment). These patients were described in 16 reports in the medical literature with their symptoms and treatment outcomes [3-19]. 

In their series of 32 patients Neto et al [13] showed that seven patients died after intoxication episodes. The main characteristics of the patients who died were convulsive activities in 6 and severe mental confusion in all 7 patients, while 2 of them presented hemodynamic instability (hypotension and shock). Most of the patients who died were treated by peritoneal dialysis or did not receive any other kind of treatment. The other 25 patients improved without sequelae and they were treated either by conventional hemodialysis, daily hemodialysis (6 to 8 hours duration) or even by continuous methods of dialysis. A few patients were treated by peritoneal dialysis. Complete recovery time in these 25 patients ranged from 1 to 12 days (mean 4.4 days and median 4.0 days). 

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