Abstract
Turbid peritoneal dialysate in patients treated with CAPD is one of the signs predicting infectious peritonitis. We experienced 3 cases with turbid peritoneal dialysate who did not have infectious peritonitis. All three had chylous ascites. The milky white color of chylous ascites was visually indistinguishable from that of infectious peritonitis. No clinical manifestations suggestive of infectious peritonitis were observed. The cell counts of the turbid peritoneal dialysates were under 100/μl, and dialysate turbidity did not disappear after centrifugation at 3, 000rpm for 5 minutes. Analysis of the dialysates revealed elevated triglyceride contents consistent with chylous ascites. The turbid peritoneal dialysate of case 1 developed during the course of IPD, and was suggested to be due to repeated mild trauma to the abdominal lymphatics by movement of the catheter. In case 2, the peritoneal fluid turned milky white after the administration of a calcium channel blocker, manidipine hydrochloride, and then cleared after withdrawal of the drug. The turbid peritoneal dialysate of case 3 was present after a high lipid diet and was associated with an increase in CAPD fluid drainage volume.
When peritoneal dialysate turns milky white during the course of CAPD, the differentiation between chylous ascites and infectious peritonitis should be made promptly. Moreover, the multiple etiologies of chylous ascites warrant further discussion.
