KEY ASSESSMENTS
The clinical presentation of peritonitis may include any of the following: cloudy effluent, abdominal pain, fever, and acutely declining peritoneal ultrafiltration.
Clinical Diagnosis:1
- Peritonitis is diagnosed when at least 2 of the following are present: (1) clinical features consistent with peritonitis, i.e., abdominal pain and/or cloudy dialysis effluent; (2) dialysis effluent white cell count > 100/μL or > 0.1 x 109/L (after a dwell time of at least 2 hours), with > 50% polymorphonuclear; (3) positive dialysis effluent culture.
- We recommend that PD patients presenting with cloudy effluent be presumed to have peritonitis and treated as such until the diagnosis can be confirmed or excluded.
- We recommend that PD effluent be tested for cell count, differential, Gram stain, and culture whenever peritonitis is suspected.
- WBC count depends on length of dwell; therefore, in APD use %PMN vs absolute WBC count to diagnose peritonitis.
- If patient is dry, instill 1 L of dialysate for a 1–2 hour dwell. Use % PMN for diagnosis.
Differential Diagnosis of Cloudy Effluent:
- Culture-positive infectious peritonitis2
- Infectious peritonitis with sterile cultures2
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- recent antibiotic usage2
- technical problems with culture technique2
- unusual organisms (filamentous fungus, mycobacteria, legionella, nocardia, and other fastidious bacteria)2 – infectious causes of cloudy effluent (see Appendix)
- Chemical peritonitis1
- Calcium channel blockers1
- Eosinophilia of the effluent1
- Hemoperitoneum1
- Malignancy (rare)1
- Chylous effluent (rare)1
- Specimen taken from “dry” abdomen1
- Noninfectious causes of cloudy effluent1 (see Appendix)