Thursday, May 13, 2010

CONSULT ROUNDS: Peritonitis

Peritonitis is a tough complication to deal with when someone is on PD. It is becoming rare as good practices are being done.
Few things we learned at consult rounds that are not any thing new but good points to keep in mind
1. Always get a PD fluid cell count, culture, gram stain
2. Don't forget, if frequent peritonitis patient:- get a fungal culture as well, check an amylase level
3. Think of perforation if multiple organisms are noted and pain is unbearable
4. Keep in mind catheter position. it might have moved??
5. In the right context, TB peritonitis is possible
6. Start standard gram positive( more common) than gram neg coverage. Choice of antibiotics can be based on the incidence of enterococcus and MRSA at your institution. Cephazolin + Ceftazadime or Vanco + ceftazadime  are good combinations
7. Gent can be used ONLY in patients with NO residual function
8. Heparin 500Units or 1000Units/ Liter bag for prevention of fibrin formation as well
9. Tailor your antibiotics to the culture results

A nice set of guidelines are set by the PD society
Check it out at http://www.ispd.org/lang-en/treatmentguidelines/guidelines

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