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:
Information based on ISPD 2005 guidelines for PD-related peritonitis
Classic manifestation of Wernicke’s Syndrome is isolated abducens nerve (CN XI) palsy.
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.
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Differential diagnosis of ST-elevations on EKG
- ST elevation MI!
- Aortic dissection
- Hypertensive crisis
- Aortic stenosis
- Cocaine use
- Early repolarization
- Brugada Syndrome
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