ACUTE HYDROTHORAX DURING PERITONEAL-DIALY SIS - 2 PEDIATRIC CASES

Peritoneal dialysis (PD) is widely used in chronic and acute disorders , Acute hydrothorax (AH) is a complication of PD that contraindicates further use of the method. Two cases are reported herein. One patient was a 13-year-old girl with endstage renal failure due to steroid-resi stant nephrotic syndrome, Three days after initiation of PD (4 x 1250 ml/day), she developed cough and dyspnea due to right-sided hydrothora x. Chemical analysis showed that the fluid in the pleural cavity was p eritoneal fluid, The hydrothorax persisted despite dialysate volume re duction, Because construction of an arteriovenous fistula was not feas ible (because of thrombotic complications), talc poudrage of the pleur al cavity was performed. Pleuroscopy failed to locate the communicatio n through the diaphragm, PD was resumed after ten days with no further complications, The other patient was a six-year-old boy with acute re nal failure due to hemolytic uremic syndrome. Forty-eight hours after the beginning of PD (12 cycles/24 hours, 30 ml/kg), a positive fluid b alance and impaired breathing suggested right-sided hydrothorax. This diagnosis was confirmed by findings from a physical evaluation and pla in chest film. PD was stopped and intermittent hemodialysis via a Quin ton intracaval catheter was initiated. The outcome was favorable. Hydr othorax is an infrequent complication of PD that should be looked for when respiratory symptoms develop after PD initiation or when the flui d balance is positive. Continuation of PD can lead to respiratory dist ress. In most cases, the hydrothorax persists despite a decrease in di alysis volume or temporary discontinuation of PD, requiring use of ano ther dialysis method. Pleural poudrage can be performed in the few cas es where no alternative to PD is available.