Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders>>>>>Renal Replacement Therapy
Question 8#

A 55-year-old female with a history of chronic obstructive pulmonary disease and chronic kidney disease on peritoneal dialysis (PD), presents to the emergency department with fever, dry cough, and wheezing. She does not complain of any abdominal pain. An upper respiratory tract infection is suspected. On admission, her hemoglobin is 9.8 mg/dL, white blood cell count is 11.2 K/µL, and lactate 3.8 mmol/L. Her vital signs are:

• BP 100/70 mm Hg
• HR 88 bpm
• oxygen saturation 95% on room air

She has been afebrile since admission.

What is the MOST appropriate next step in the management of this patient?

A. Abdominal computerized tomography scan to confirm diagnosis of bowel ischemia
B. Admit to the ICU as she is likely to develop peritonitis and septic shock
C. Observation and treatment of symptoms
D. Start on empiric antibiotic therapy

Correct Answer is C

Comment:

Correct Answer: C

Lactate is the most commonly used buffer in PD solutions. An abnormal lactate value is often seen in PD patients presenting to the ED. It does not necessarily indicate tissue hypoperfusion or gut ischemia. This patient with acute respiratory symptoms needs to be treated and observed for any further worsening. Hyperlactatemia could be a coincidental occurrence in patients who undergo PD.

References:

1. Trinh E, Saiprasertkit N, Bargman JM. Increased serum lactate in peritoneal dialysis patients presenting with intercurrent illness. Perit Dial Int. 2018;38(5):363-365.
2. Anderson YS, Curtis NJ, Hobbs JA, et al. High serum D-lactate inpatients on continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. 1997;12(5):981-983.