INFECTIOUS DISEASE

ResponseHistory
Gradual onset, constant pain
Cloudy dialysate bag

Examination
Generalised tenderness
Signs of peritonism (eg: percussion tenderness)
Fever

Investigation
Fluids >100 WBC’s, >50% neutrophils

ResponseFocal tenderness
Colicky pain
Sudden onset pain
Non abdo findings eg: PR bleeding
others

ResponseCloudy dialysate bag and >= 2 Fever, abdo pain, nausea, vomiting, diarrhea
PD fluid shows WCC >100 and >50% PMN
Positive gram stain or culture

ResponseAdd to (intermittent) dialysate bags (Note continuous has different method. In answer just say “Change to intermittent dialysis and leave for at least 6 hours)
IP cefazolin 15 mg/kg PLUS
IP gentamicin 0.6 mg/kg (to 50 mg)
+/- Metronidazole if perforated viscous/diverticulitis suspected.
+/- IP vancomycin 30 mg/kg to 2g if MRSA suspected (not routine as can induce VRE)

Analgesia - Fentanyl 25 mics until comfort achieved
eTG Aug ‘24