Fluid and Electrolyte Complications of Peritoneal Dialysis

Abstract

One or more of the following complications developed in five patients during peritoneal dialysis: hypovolemia, hypernatremia, alkalosis, and hyperglycemia. Possible causes are considered, and the composition and use of commercially available dialysis solutions are reviewed. The relatively high sodium and lactate content of some solutions predisposes to hypernatremia and alkalosis, which occur particularly when rapid dialysate fluid and weight loss are associated with hypertonic solutions. Complications are commonest with 7% dextrose solutions, which are seldom necessary. Excessive fluid loss may occur with 1.5% dextrose solutions, particularly in patients receiving recurrent peritoneal dialysis. The value of a 0.5% dextrose solution with 135 mEq/liter of sodium and 34.5 mEg/liter of lactate under special circumstances is illustrated. Dialysis solutions should be chosen from a group with various tonicities and electrolyte compositions after consideration of the patient's serum osmolality, concentrations of serum sodium and bicarbonate, state of fluid balance, and glucose tolerance. Changes can then be made as necessary, as these factors are reevaluated at intervals during dialysis. Complications can ordinarily be prevented by anticipating problems and appropriate management.