What is the appropriate diagnostic workup of peritonitis in a patient undergoing Peritoneal Dialysis?
Upon presentation by any patient on PD with symptoms of either abdominal pain or cloudy effluent, a diagnosis of peritonitis should be entertained and ruled out. However, the clinician should also be mindful of other non-PD-related causes of these symptoms, such as a ruptured viscus, diverticulitis, cholecystitis, ischemic bowel, or pancreatitis. Prompt diagnosis and treatment are imperative for best outcomes in PD-related peritonitis and any of the other conditions.
A sample of PD effluent that has ideally been dwelling in the peritoneum for at least 1 to 2 hours should be obtained by the patient or health care provider. The effluent fluid is sent to the laboratory for cell count, gram stain, and microbial culture. The diagnosis of peritonitis requires at least two of the following three features:
- 1. Peritoneal fluid leukocytosis (>100/mm 3 and at least 50% polymorphonuclear cells)
- 2. Abdominal pain
- 3. Positive culture of the dialysis effluent