- [Show abstract] [Hide abstract] ABSTRACT: We have investigated whether blood ammonia is increased with worsening CKD. Fifty eight subjects with a range of CKD were recruited for analysis of plasma ammonia and other electrolytes. The concentrations of plasma ammonia were all within the normal reference range and there was no correlation between ammonia and CKD without any effect of dialysis. Blood ammonia is not elevated in or related to the severity of chronic kidney disease.
- [Show abstract] [Hide abstract] ABSTRACT: Pseudohyperkalaemia may result from delay in centrifugation and storage at 4°C. We investigated whether the stage of chronic kidney disease (CKD), its aetiology or medications influence this. Seventy-seven patients with CKD were recruited. Lithium heparin plasma samples were analysed for sodium, potassium, urea and creatinine, chloride, bicarbonate, magnesium, calcium and inorganic phosphate at 0 h and after storage of whole blood at 4°C for 6 h and 20 h. K-EDTA and fluoride-EDTA samples were analysed for full blood count and glucose at 0 h. CKD stage was determined by standard criteria. K(+) increased on average by 1.0 and 3.6 mmol/L after 6 and 20 h storage of whole blood at 4°C, independent of cause or stage of CKD. K(+) increase at 6 h was correlated with haemoglobin but not with white blood cell count, platelet count or glucose. Patients taking ACE inhibitors and/or angiotensin receptor blockers (ARBs) had slightly higher K(+) at 0 h and increased K(+) after storage for 6 h. Na(+) decreased on average by 3.8 mmol/L at 20 h and was independent of CKD stage, and correlated with K(+) increase. K(+) increased significantly with time in samples stored at 4°C in all stages of CKD. This was greater in some patients on ACE inhibitors and ARBs, and increased with haemoglobin, but was not related to the stage of CKD, white blood cell count or platelet count for the samples used in this study.
- [Show abstract] [Hide abstract] ABSTRACT: The pneumoperitoneum (PP) on upright chest X-ray (CXR) usually indicates a perforated viscus. As peritoneal dialysis (PD) catheter provides an additional port of air entry into the peritoneal cavity, the incidence and clinical significance of PP in PD patients has been debated in the literature (a variable incidence from 4 to 34% has been reported in previous studies). With improvement in patient training and connecting devices of PD catheters, technique-related PP is quite rare. Following a recent patient with PP, we reviewed our 3-year data to evaluate the incidence and significance of this radiological sign in PD patients. We reviewed all upright CXRs in our PD patients from 2006 to 2008, using an electronic radiology database. Over 3 years, we had a total of 156 patients on PD. We have reviewed a total 312 upright CXRs (mean 2 X-rays per patient), which were performed for various clinical reasons during this period. Seven PD patients had 11 CXRs showing free air under the diaphragm (total incidence of PP 4% of PD population and 3% of CXR performed in PD patients). One patient had two episodes of PP with a total of four X-rays demonstrating free air. Two patients had surgical complications of PD catheter insertion and PP was diagnosed just after the insertion of PD catheter, both of them needed laparotomy. Five patients had incidental PP, which was possibly technique related. In four of these patients with incidental PP, no definite intervention was needed. However, one of these five patients was symptomatic. We established that the cause of PP was faulty technique. Aspiration of PP with a patient in the Trendelenburg position gave her immediate symptomatic relief. We also retrained her to prevent further episodes of PP. This review demonstrates the quite low and falling incidence of PP (<4% in a prevalent PD population) most likely due to improvement in training and technique. The air should not enter the peritoneal cavity in normal properly performed exchanges. Air under the diaphragm in a PD patient requires appropriate evaluation to exclude visceral perforation. After that, patient technique of PD exchanges should be reviewed. However, if PP persists, aspiration of air can give symptomatic relief.