acute peritoneal dialysis prescription

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Acute peritoneal dialysis PrescriptionYousaf khanLecturer Renal diaysisIPMS-KMU

IntroductionProvide nephrologist with non vascular alternative dialysisUse intensive care setting, actually less efficient that conventional dialysisIts continuous nature comparable with dxManagement of actual renal failure with toxic or metabolic, electrolyte, volume problem in critical ill patientUse in children it low cost make attractive

Advantage: simple than other mode of dxDoes not require highly trained person or expensive complex equipmentPerform usually manually but can be done by cycleAvoid vascular problem like hemorrhage, air embolism and thrombosis etsDoes not require anticoagulationHemodynamicaly instability, lacked blood hemodialyzer reaction

Disadvantage: PD is less efficient than hemodialysis in the treatment of acute problem like pulomary edema, poisonings or drug overdose, acidosis and hyperkalemia etsProtein losses can be substantial in PD and could complicate the care of already malnourished, critically ill patients.Morbidity 30% and mortality 5%

Indication: Acute renal failureHemodynamically unstable patients Patient in whom vascular access is problematic

Contraindication:Recent surgery requiring abdominal drainsFungal peritonitisSevere hypercatabolic states and abdominal wall cellulitis Peritoneal fibrosis herniaBig poly cystic kidney

Peritoneal catheter:Initial insertion of a Tenckhoff catheter

Use of Automated cyclers: Traditionally been done using manual exchangesAPD with considerable saving time

Prescribing acute peritoneal dialysis:A: Session length: In the setting of acute renal failure, continous removal of fluids and solutes is required in a patient who often is catabolic, oliguric and in need of ongoing nutritional and therapeutic support.24 hr at a time, reassessing and altering the prescription as indicated.

B: Exchange volume:Depend size of peritoneal cavityAverage size adult can usually tolerate 2L exchangeSome nephrologist prefer to start with smaller volume 1-1.5L for the first few exchange.

C: Exchange time:Combine time required for inflow, dwell and drainMost commonly use 1hr, although 2hr exchange time also are commonly.Inflow 10 mint, dwell time 30 mint and outflow 20 -30 mint

Acute peritoneal dialysis order

Prescribing acute peritoneal dialysis:D: Choosing the dialysis solution dextrose concentration:

E: Dialysis solution additives:Potassium, Heparin (1000 units/2L) and Insulin (administration may be required for diabetic patient)

Prescribing acute peritoneal dialysis:F: Monitoring fluid balance

G: Monitoring Clearance:

ComplicationA number of problems may arise during the course of acute peritoneal dialysisAbdominal distention:Incomplete drainage may lead to progressive intraperitoneal accumulation of dialysate with attendant discomfort, distention, and even respiratory compromise.

Peritonitis: Peritonitis may complicate acute peritoneal dialysis in up to 12% of cases.This is occurs most often within the first 48hrInfection from gram positive dominant

Hypotension: Rapid removal of large amounts of fluid can lead to hypovolemia with consequent hypotension, arrhythmia and even death.

ComplicationHyperglycemia: In the daibetic or prediabetic patient, the high dextrose solutions used for peritoneal dialysis can result I hyperglycemia.

Hypernatremia

Hypoalbuminemia:With the frequent exchanges utilized in acute peritoneal dialysis, protein loss via the dialysate can be as high as 10 20g per day and up to twice this amount if peritonitis.

Thank You

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