Acute peritoneal dialysis prescription by Yousaf khan Lecturer Renal Dialysis IPMS- KMU

1. Acute peritoneal dialysis
Prescription
Yousaf khan
Lecturer Renal diaysis
IPMS-KMU

2. Introduction
 Provide nephrologist with non vascular alternative dialysis
 Use intensive care setting, actually less efficient that conventional
dialysis
 Its continuous nature comparable with dx
 Management of actual renal failure with toxic or metabolic,
electrolyte, volume problem in critical ill patient
 Use in children it low cost make attractive
Advantage:
 simple than other mode of dx
 Does not require highly trained person or expensive complex
equipment
 Perform usually manually but can be done by cycle
 Avoid vascular problem like hemorrhage, air embolism and
thrombosis ets
 Does not require anticoagulation

3. Disadvantage:
 PD is less efficient than hemodialysis in the treatment of acute
problem like pulomary edema, poisonings or drug overdose,
acidosis and hyperkalemia ets
 Protein 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 failure
 Hemodynamically unstable patients
 Patient in whom vascular access is problematic

4. Contraindication:
 Recent surgery requiring abdominal drains
 Fungal peritonitis
 Severe hypercatabolic states and abdominal wall cellulitis
 Peritoneal fibrosis hernia
 Big poly cystic kidney
Peritoneal catheter:
 Initial insertion of a Tenckhoff catheter
Use of Automated cyclers:
 Traditionally been done using manual exchanges
 APD with considerable saving time

5. 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 cavity
 Average size adult can usually tolerate 2L exchange
 Some 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 drain
 Most commonly use 1hr, although 2hr exchange time also are
commonly.

6. Acute peritoneal dialysis order

7. 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)

8. Prescribing acute peritoneal dialysis:
F: Monitoring fluid balance
G: Monitoring Clearance:

9. Complication
 A number of problems may arise during the course of acute
peritoneal dialysis
Abdominal 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 48hr
 Infection from gram positive dominant
Hypotension:
 Rapid removal of large amounts of fluid can lead to hypovolemia
with consequent hypotension, arrhythmia and even death.

10. Complication
Hyperglycemia:
 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.

11. Thank