Unusual cases of peritonitis: A case series of five patients.

INTRODUCTION: Peritonitis is a complication in patients on peritoneal dialysis that frequently results from touch contamination. Most cases of peritoneal dialysis-related peritonitis are caused by skin organisms. Herein, we are presenting a series of peritonitis cases with unusual organisms in a single home dialysis center at an academic hospital in New York City. METHODS: The records of five patients with an unusual cause of peritonitis were reviewed by a clinician. We have chronologically tabulated the cell count of the dialysate, microbiologic cultures, and antibiotics received by each patient. Additionally, both a table and figure detail the microbiologic organisms that our dialysis unit encountered over the 3-year period concurrent with the infections reported. RESULTS: The first patient presented with refractory polymicrobial peritonitis due to a liver abscess. Another patient presented with diverticulitis and developed enteric peritonitis with various organisms. The following patient had peritonitis in the setting of bowel pathologies and from Rhizobium after exposure to plants. The next patient developed Pasteurella peritonitis from his cat. The final patient developed multiple episodes of peritonitis from organisms including flora native to soil and water. CONCLUSION: These uncommon cases of peritonitis with unusual circumstances bring awareness to various elements that can lead to peritonitis.

Toxicity of Herbs, Vitamins, and Supplements.

In the United States, the Food and Drug Administration regulates the efficacy and safety of pharmaceutical drugs. This government agency was formed in direct response to a mass poisoning and more than 100 deaths from kidney failure due to a medicinal toxic alcohol exposure. In contrast, the Food and Drug Administration also regulates the use of vitamins, minerals, herbs, or botanicals as dietary supplements, banning specific medical claims but requiring no documentation of efficacy. Safety of dietary supplements is only ensured through reporting of adverse events and rarely through intervention. Consumers should be aware that supplements may in fact contain actual pharmaceuticals or nothing of value and have significant toxic potential. Toxicity due to Chinese herbal medicines, aristolochic acid, amygdalin, hypervitaminosis D, and heavy metal contamination is reviewed.

Hepatorenal syndrome treated for eight months with continuous-flow peritoneal dialysis.

The case documented here represents the longest course of continuous-flow peritoneal dialysis (PD) reported in the literature. A 61-year-old man with hepatorenal syndrome type 1 and ascites presented with hypotension and bright red blood per rectum and was found to be in acute renal failure with severe anemia. Continuous-flow PD was initiated, and the patient improved clinically. The patient died of a jejunal bleed 8 months later, before discharge. Acute PD or continuous-flow PD is a viable alternative in the setting of hemodynamic instability and ascites, can be used as a chronic modality, and addresses many of the weaknesses of continuous ambulatory and automated PD.