Category Archives: Clinical Pearls

Clinical Pearls: PD-related peritonitis

One of the most common complications of peritoneal dialysis is peritonitis. Things to remember:

  • Diagnosis: Peritoneal fluid with >100 nucleated cells (usually >50% PMNs)
  • Pathophysiology: Skin-related (usually gram positive) vs. Secondary (enteric, usually gram-negative and polymicrobial)
  • Empiric treatment: Should cover gram positive and negative organisms. A frequently used combination is a first-generation cephalosporin (i.e. cefazolin) plus an anti-pseudomonal cephalosporin (i.e. cefepime). If the patient or population has a high frequency of methicillin-resistant organisms, vancomycin is a reasonable choice for gram-positive coverage.
  • Drug delivery: Intra-peritoneal (IP) preferred to intravenous (IV) route due to increased local concentration with IP. Vancomycin, aminoglycosides and cephalosporins can be mixed with dialysate solution and achieve therapeutic blood levels (must monitor closely)
  • Indications for catheter removal:

Screen Shot 2015-09-22 at 10.11.03 AM

Information based on ISPD 2005 guidelines for PD-related peritonitis

Cheers to a Great Year!

To the Housestaff, Faculty, Fellows, and Students,
As our year with you ends, we want to take a moment to thank you. Thank you for your dedication, your professionalism, your curiosity, and your commitment to the best quality patient care. Thank you for being expert clinicians, accomplished researchers, and outspoken advocates for your patients. Thank you for helping open a brand new hospital, for being the best recruiters in the world, and for rising to the challenge of potpourri. Thank you for supporting us, for standing by our side, for voting on the case challenges, and for reading this blog! In short, thank you, for an amazing year – we know that next year will be even better!
– Your 2014-2015 Chief Residents (Punag, John, and Kate)

Bronchiectasis 101

Below are some key points regarding bronchiectasis:

  • Damage to the airways causing them to widen and become scarred. This causes impaired clearance of mucous resulting in buildup and recurrent lung infections.
  • Congenital etiologies (cystic fibrosis, primary ciliary dyskinesia, alpha-1 antitrypsin deficiency) versus acquired (post-infection, idiopathic, aspiration, immunodeficiency, auto-immune, ABPA).
  • Patients presents with chronic cough and sputum production. Affects women more than men.
  • Typically diagnosed by high resolution CT scan.
  • At risk for chronic colonization by Pseudomonas.
  • Typical infectious organisms include H. influenzae, Pseudomonas, Moraxella catarrhalis, Mycobacterium, Staph.
  • Treatment: Treat underlying condition, antimicrobrial therapy, surgical resection, lung transplant for end stage disease.

O’Donnell. CHEST. 2008.

Causes of asymptomatic microscopic hematuria

Excellent board-review lecture today by Dr. Sambandam! He is a little clinical pearl, the causes of asymptomatic microscopic hematuria:

  • Benign essential Hematuria (37%)
  • Benign Prostatic Hyperplasia (24%)
  • Urethral Infection (21%)
  • Urinary Tract Infection (7%)
  • Nephrolithiasis (4%)
  • Urethral calculus (2%)
  • Bladder tumor (2%)
  • Renal Cyst (1.5%)
  • Renal tumor (0.5%)

#clinicalpearls: Hepatitis B & D

  • Hepatitis B
    • HBsAg → active infection
    • HBsAb → past infection or vaccination against hepatitis B
    • HBeAg → active replication of the virus
    • AntiHBc IgM → acute infection
    • AntiHBc IgG → chronic infection
    • Chronic, and carrier states will have positive HBsAg and Anti-HBcIgG. How can these two conditions be differentiated?
      • Chronic → Increased LFTs
      • Carrier → Normal LFTs
  • Hepatitis D: requires Hepatitis B infection to be present
    • Anti-HBc IgM + Hepatitis D virus → acute co-infection and will not worsen hepatitis
    • Anti-HBc IgG + Hepatitis D virus → acute super-infection and can cause fulminant hepatitis