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Recurrent Acute Hydrothorax in a CAPD Patient: Successful Management with Small Volumes of Dialysate

Editar: A 46-year-old male with renal failure secondary to nephrosclerosis had been on continuous ambulatory peritoneal dialysis (CAPD) for 6 months. While he was on 4 exchanges with 2 L of dialysate per day, he developed acute dyspnea due to a large right pleural effusion. Thoracentesis revealed a transudative effusion with a glucose concentration of306 mg/dL and a normal (17 mm/L) concurrent blood glucose. Intermittent low volume peritoneal dialysis was performed for 6 weeks to allow the defect in the diaphragm to heal. The pleural effusion was gradually drained to the peritoneal cavity. Although we performed contrast peritoneography, peritoneopleural fistula was not identified. CAPD was restarted with low volume exchanges and finally increased to 2 L. The very first day we used 2-L exchanges, acute severe hydrothorax reappeared. The effusion was tapped to dryness and CAPD restarted with 5 exchanges of 1.5 L. He has been maintained on this schedule for over 6 months now without recurrence of the hydrothorax.