Showing papers on "Peritoneal dialysis published in 1974"

Treatment of severe fluid overload by ultrafiltration

Abstract: A recently developed ultrafiltration cell was clinically evaluated and found to remove excess sodium and water efficiently, rapidly, and inexpensively from fluid-overloaded patients on chronic hemodialysis. The extracorporeal circuit is designed to run in series with the artificial kidney or as a separate unit. With constant blood flow, ultrafiltration flux rate increased as a linear function of transmembrane pressure up to 200 mm Hg. Ultrafiltration rates of 300 to 800 ml per hour were readily achievable, and the fluid removal rate was quantitated and adjusted as the clinical picture dictated. Complications of ultrafiltration were rare and included leg cramps and orthostatic hypertension. The solute concentrations in the ultrafiltrate were identical to plasma water, thereby avoiding electrolyte and acid-base disturbances. This therapy is simpler and safer than peritoneal dialysis or hemodialysis; we speculate that it could logically be extended to patients with refractory chronic edematous state...

Hyperuricemic acute renal failure.

Abstract: Sixteen patients with hyperuricemic acute renal failure were treated or had their cases reviewed. Eleven of the patients were treated with dialysis and five were treated conservatively. The prognosis is excellent, as all survived acute renal failure, and renal function rapidly returned to normal after lowering of the uric acid level with dialysis. Dehydration and ureteral obstruction were rare causes of acute renal failure, and prophylactic allopurinol and potent diuretics were not always successful in preventing or aborting it. A high phosphorus-to-uric-acid ratio occurred where hyperuricemic acute renal failure occurred as a complication of chemotherapy with precipitous falls in peripheral white blood cell counts. Hemodialysis is the treatment of choice, being 10 to 20 times more efficient than peritoneal dialysis in the removal of uric acid, and there is no disequilibrium even with rapid hemodialysis.

Tetracycline Poisoning in Renal Failure

Abstract: Seven cases are reported in which drugs of the tetracycline group produced a fall in the glomerular filtration rate. In six patients there was a primary underlying renal disease and renal impairment. All seven patients were made seriously ill by the antibiotic. Two patients required immediate haemodialysis; one died and the other continued on dialysis until transplanted. Another patient initially responded to intravenous fluids and protein restriction but his renal function deteriorated and four months later he began maintenance haemodialysis. Three patients required peritoneal dialysis. The seventh patient responded satisfactorily to conservative management. The medical and medicolegal complications arising from the use of tetracycline in patients with renal disease are discussed. Yet another plea is made that drugs of the tetracycline group other than doxycycline should not be given to patients with chronic renal failure.

Peritoneal dialysis today: a new look.

Abstract: Peritoneal dialysis, its indications and contraindications are reviewed in the light of recent technical developments and clinical experience with 69 patients on maintenance treatment. Protein depletion and peritonitis can no longer be considered inevitable endpoints of acute or chronic peritoneal dialysis. Based on an extensive experience in both hemodialysis and peritoneal dialysis, it is suggested that perhaps as many as 20–25% of patients in need of dialysis should preferentially receive peritoneal dialysis treatment.

Methanol intoxication. Comparison of peritoneal dialysis and hemodialysis treatment.

Abstract: A unique opportunity presented itself for reviewing and comparing the results of two different methods of dialytic therapy for the treatment of methanol (methyl alcohol) poisoning The group that was treated with hemodialysis initially had a faster fall in serum methanol level, regained consciousness faster, had a shorter hospital stay, and, most importantly, had no residual effects when compared with the group treated with peritoneal dialysis In this group, one patient died and another was permanently blinded Therefore, we believe that hemodialysis, when available, is the initial treatment of choice in methanol poisoning and should be used concomitantly with alkaline therapy and the administration of alcohol (ethanol, ethyl alcohol)

Reye's syndrome:clinical diagnosis and treatment with peritoneal dialysis.

Abstract: Twenty-four cases of Reye9s syndrome are studied with regard to the effect of peritoneal dialysis on survival and with regard to the clinical criteria for diagnosis. A good correlation is observed between the typical clinical presentation with abnormal prothrombin time, SGOT, SGPT and blood ammonia levels and the abnormal liver histology described in Reye9s syndrome. Of the 11 patients treated with hepatic coma regimen and peritoneal dialysis, 9 (82%) lived. Two of the 13 patients (15%) treated only with the hepatic coma regimen lived (p

Minocycline excretion and distribution in relation to renal function in man.

Abstract: SUMMARY 1. The biological half-life of minocycline in serum has been studied in twenty-one patients and shown to have no relationship to renal function. There is very little excretion of minocycline by the kidney, and practically none is removed by dialysis. 2. In normal subjects, minocycline therapy is not accompanied by a significant rise in blood urea concentration or urinary urea excretion. However, high doses may produce a marked increase in urea excretion. 3. Of eight patients with impaired renal function who were treated with a normal therapeutic dose of minocycline (200 mg/day), one showed a significant increase in urea excretion and a rise in plasma urea concentration. Two patients with severe unstable renal failure required dialysis following therapy. 4. Minocycline is unlikely to accumulate in patients with renal failure due to its predominantly gastrointestinal excretion and is therefore safe to use. However, its protein catabolic effect is dose dependent and if renal function is impaired, even a small increase in urea production may be sufficient to aggravate uraemia. In such patients the normal therapeutic dose (200 mg/day) should not be exceeded and monitoring of renal function is advisable.

Pharmacokinetics of Tobramycin in Patients with Stable Renal Impairment, Patients Undergoing Peritoneal Dialysis, and Patients on Chronic Hemodialysis

Abstract: The pharmacokinetics of tobramycin were studied in five patients with stable renal impairment, four patients requiring peritoneal dialysis, and four patients on chronic hemodialysis. The half-life of the drug varied with the level of the serum creatinine in the first group of patients, and the average volume of distribution was 15 liters. Only 49% of the administered dose of tobramycin was recovered during 36 h of peritoneal dialysis. The average clearance of tobramycin during hemodialysis was 49.1 ml/min, and 51.5% of the administered dose was recovered during a 6-h dialysis.

Ascites in Patients on Maintenance Hemodialysis

Abstract: Intractable ascites is encountered with increasing frequency in patients undergoing chronic hemodialysis. Eight patients out of 68 developed moderate to massive ascites. Peritoneal dialysis antedated

The treatment of lactic acidosis in the diabetic patient by peritoneal dialysis using sodium acetate. A report of two cases.

Abstract: Lactic acidosis is a rare but serious complication of the use of biguanides in anti-diabetic therapy. This report details two cases of diabetic lactic acidosis secondary to Metformin, successfully treated by peritoneal dialysis, using sodium acetate as the dialyzing substance. The author emphasizes the use of extra-renal purification, and more specifically peritoneal dialysis, as symptomatic therapy of lactic acidosis in the diabetic patient. Acetate, rather than lactate, as the dialyzing substance, is most justified from a biochemical point of view.

Removal of mercury by peritoneal dialysis.

Abstract: Acute poisoning with mercury bichloride is not common today. Recently, we had the opportunity to treat a hospital employee within minutes after he ingested 4 to 8 gm of mercury bichloride. Nevertheless, he developed acute renal failure. In conjunction with peritoneal dialysis we were able to collect and analyze data on the peritoneal clearance of mercury. Patient Summary A 35-year-old male hospital pharmacy employee ingested 4 to 8 gm of mercury bichloride and several glutethimide (Doriden) tablets. He was immediately taken to the emergency ward; gastric lavage with sodium bicarbonate and milk was begun within five minutes of ingestion and 350 mg of dimercaprol (BAL) was given intramuscularly within 30 minutes. The gastric lavage initially returned copious amounts of bluish tinted material but soon turned bloody. Within several minutes the patient was complaining of burning abdominal pain and excessive salivation. The patient had been hospitalized for hypertension and mental depression

Recurrent ascites following peritoneal dialysis. A new syndrome

Abstract: Four patients with end-stage renal failure developed recurrent ascites following one or more peritoneal dialyses with hypertonic dialysis solution (7% dextrose). No cause for this ascites could be found, although peritoneal biopsy specimens revealed a chronic inflammatory picture. At no time had peritonitis, chemical or bacteriological, been evident. The ascites persisted during the first few months of intermittent hemodialysis therapy and, in two cases, resolved following laparotomy.

Immunoglobulin and Dextran Losses During Peritoneal Dialysis

Abstract: Losses of immunoglobulins were measured in ten patients undergoing peritoneal dialysis. Mean immunoglobulin losses per 80 liter dialysis were as follows: IgG 17.9 gm, IgA 3.8 gm, and IgM 0.78 gm. Bleeding during dialysis generally accounted for less than 10% of these losses. lgA/lgG and lgM/lgG ratios in dialysate and serum were similar suggesting that the peritoneal membrane is permeable to higher molecular weight molecules. This was confirmed by the demonstration of peritoneal permeability to dextrans of greater than 150,000 molecular weight. In the absence of compensatory increases in synthesis, losses of immunoglobulins of the magnitude described in patients on chronic peritoneal dialysis programs could result in hypoglobulinemia and altered host resistance.

Reduction of plasma propionate by peritoneal dialysis.

Abstract: In a child with propionic acidemia, biochemical relapse associated with septicemia was successfully treated with peritoneal dialysis. It is suggested that this line of management is suitable for the management of biochemical crises in propionic acidemia.

Administration of Ticarcillin, a New Antipseudomonal Antibiotic, in Patients Undergoing Dialysis

Abstract: Ticarcillin was administered to three groups of patients in chronic renal failure; three were undergoing chronic hemodialysis, two were undergoing peritoneal dialysis, and three received the drug after hemodialysis The serum half-lives were measured A dosage regime for patients undergoing dialysis is suggested

Peritoneal Dialysis for Isopropyl Alcohol Poisoning

Abstract: To the Editor.— Isopropyl alcohol poisoning has been successfully treated with hemodialysis.1Any substance removed by the artificial kidney can also be removed, although not quite as rapidly, by peritoneal dialysis. As in the case described, acute isopropyl alcohol poisoning can be treated successfully with peritoneal dialysis. Report of a Case.— In 1965, after an automobile accident, a 26-year-old man incurred a basal skull fracture and a brainstem contusion. Because of an incomplete recovery, he was mentally retarded and disabled. He had been in otherwise good health until April 17, 1974, when he was admitted to a hospital for the loss of consciousness following a fall in his bathroom. He was semicomatose and responded to deep pain only. He gave off a strong odor of alcohol. A nasogastric lavage yielded coffee-ground material. He was treated with intravenously administered fluids (5% dextrose in water), nasogastric suction, and peritoneal dialysis, which was

Elimination of diatrizoate by peritoneal dialysis in renal failure.

Abstract: High doses of contrast media containing iodine have proved to be of considerable diagnostic value for urography in renal failure (STAGE et coll, 1971, 1973). Normal subjects excrete diatrizoate almost exclusively by glomerular filtration (DENNEBERG 1965). Impairment of renal function delays excretion and increases extrarenal elimination, which takes place mainly through the liver (HANSSON & LINDHOLM 1963). STAGE et coll, (1971) and MILMAN & STAGE ( 1974) demonstrated that high doses of diatrizoate in patients with renal failure may cause further deterioration in renal function, sometimes making rapid removal of the medium desirable. The present investigation was therefore undertaken to assess the value of peritoneal dialysis for this purpose.

The effects of the production of sodium depletion by peritoneal dialysis with 5% glucose on the volume and composition of the extracellular fluid of dogs

Abstract: 1. The volumes and compositions of the extracellular and peritoneal fluids were monitored in functionally nephrectomized dogs during a period of 4 hr of peritoneal dialysis with 5% glucose. 2. The extracellular fluid volume ([14C]mannitol space), sodium, potassium and chloride concentrations decreased, while the peritoneal fluid volume, sodium, potassium and chloride concentrations increased. 3. Movement of water from the e.c.f. to non-extracellular sites occurred, reaching a maximum after 1 hr; thereafter, the movement of water was first reduced, and later reversed. 4. From the volumes and compositions of the extracellular and peritoneal fluids, the total contents of solutes in the two compartments were calculated. 5. There was a mobilization of sodium and chloride from non-extra-cellular sites, which became significant after 2 hr of dialysis, and increased throughout the remainder of the period of dialysis. 6. The physiological significance of these changes is discussed.

Contrasting effect of hemodialysis and peritoneal dialysis on the inhibition of in vitro calcification by uremic serum

Abstract: Our findings support the earlier observation of Yendt, Connor and Howard that uremic serum inhibits the calcification of rachitic rat cartilage in vitro. We also confirmed their studies showing that this inhibition is not the consequence of increased levels of serum magnesium or blood urea. In addition, we have shown that aqueous solutions of creatinine and uric acid in concentrations up to 20 mg./100 ml. do not cause any inhibition. Hemodialysis of uremic patients does not change the inhibitory activity of their blood. In contrast, after 24 hours of peritoneal dialysis, the blood of most patients does not inhibit calcification. The inhibitory activity of uremic serum, observed in vitro, may be important in the pathogenesis of osteomalacia in patients with renal failure. Failure of hemodialysis to alter this activity may contribute to the progression of renal osteodystrophy in patients on maintenance hemodialysis.

Removal of Iodinated Contrast Material by Peritoneal Dialysis

Abstract: Acute renal failure following administration of radiographic contrast material is being reported with increasing frequency. In this study the clearance and extraction of iodinated contrast material by peritoneal dialysis was determined in a patient who became anuric following drip infusion pyelography. During 64 h of dialysis the serum iodide concentration decreased by a factor of 10, the peritoneal clearance of iodide was 12.1 ml/min, and 56% of the administered iodide was removed. These results suggest that contrast materials can be removed by dialysis if nephrotoxicity develops.

Methanol poisoning: management of acidosis with combined haemodialysis and peritoneal dialysis.

Abstract: The management of a seaman who ingested a large quantity of methanol is described. Key diagnostic features were acidosis, tachypnœa, optic papillitis, dilated pupils, altered sensorium, and a formaldehyde odour present in the expired air and urine. Therapy included intravenous bicarbonate for correction of severe metabolic acidosis, intravenous ethyl alcohol, and combined simultaneous peritoneal and hæmodialysis. Problems encountered were bradycardia with arrhythmia, managed with atropine; respiratory arrest managed with diazepam, endotracheal Intubation, ventilatory support, and later tracheostomy; and severe hypokalæmia. Future cases should be regarded as medical emergencies and transferred to centres with facilities for rapid blood‐gas, acid‐base, and potassium measurements, and at which peritoneal dialysis and hæmodialysis with simultaneous ventilatory support are available. With early recognition and rapid treatment preservation of sight can be expected and late neurological deficits avoided.

Albumin Catabolism Measurement by a Double Tracer Technique in Uraemic Patients During a Single Dialytic Treatment

Abstract: . In order to explain the pathogenesis of protein depletion in chronic uraemia, 13 measurements of albumin catabolism were performed in uraemic patients undergoing haemo- or peritoneal dialysis treatment; during either the early phase or steady uraemic state. Catabolism was determined during a single haemo- or peritoneal dialysis by a double tracer technique (Human Serum Albumin and sodium iodide labelled with two different isotopes of iodine). The output from both albumin and iodine systems was measured in the dialysis solution flowing out from the peritoneum or artificial kidney. The radioactive iodide arising in dialysate from albumin breakdown was concentrated by the use of an anion exchange resin. Catabolic rate was three times the normal in 3 patients showing clinical features of hypercatabolism (true rapid loss of body weight) in the early phase of uraemia, or during relapse of it; albumin turnover rate returned to normal in 2 of these patients, when measured during clinical steady state conditions. This behaviour suggests highly increased catabolism, not counterbalanced by a correspondingly increased synthesis, as the cause of albumin depletion in chronic uraemia.

Acute renal failure in multiple myeloma.

Abstract: Two cases of acute renal failure complicating multiple myeloma are reported. In both, the renal failure preceded the diagnosis of multiple myeloma. In one case oliguria occurred after performance of a venogram; renal function returned to normal after two weeks of intermittent peritoneal dialysis, emphasizing the reversibility of the renal failure in some cases.

Renal tubular obstruction by mucoproteins from adenocarcinoma of pancreas.

Abstract: We report a case in which mucoproteins from an adenocarcinoma of the pancreas, released into the ascitic fluid and serum, were filtered through the renal glomeruli to form very viscous casts which obstructed the renal collecting tubules and caused the patient's death from oliguria.