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Kidney Week

Abstract: TH-PO353

A Peculiar Case of Pica in Peritoneal Dialysis (PD) Peritonitis

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Devulapalli, Pushpa, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Imber, Jared G., The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Waguespack, Dia Rose, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Teakell, Jade M., The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
Introduction

Anemia is found in majority of patients with CKD. It is associated with an increased risk of cardiovascular disease, morbidity and mortality in patients dependent on dialysis. Iron supplementation is usually advised to help improve symptoms and quality of life as well as reduce cardiovascular risk.

Case Description

Our patient is a 30 year old woman with history of ESRD secondary to anti-GBM disease on peritoneal dialysis with history of recurrent PD related peritonitis who presented to the emergency room due to abdominal pain, fevers, chills, nausea, and vomiting. She was hemodynamically stable with no leukocytosis but borderline left shift. CT of abdomen showed small bowel wall thickening. PD effluent samples were collected for gram stain and culture. Analysis showed turbidity and a WBC count of 58k with 80% neutrophils. She was started on broad spectrum antibiotics. Culture eventually grew Acinetobacter pitti. On further investigation, she reported eating dirt and clay for weeks. Bacteria of the genus Acinetobacter are ubiquitously distributed in nature, found in various types of soils. Iron panel showed low iron, low TIBC, and low ferritin. Iron was not given during admission due to active infection. Acinetobacter has a tendency to form biofilms which can cause recurrence of infection. The decision was made to keep the PD catheter in and she was sent home on a course of PO Cipro. Weeks later, she presented again with similar symptoms. During this admission, PD catheter was removed and she was transitioned to HD.

Discussion

Our case is a reminder of the surprising prevalence of pica in the ESRD population. Pica can go unrecognized until metabolic abnormalities or complications arise. Physicians do not routinely investigate pica due to underreporting and lack of information as well as guilt and fear of judgement from patients. CKD is a key player for major stress and can trigger pica. A common co-morbid condition associated with pica is anemia. Patients can have metabolic derangements such as alkalosis, hypoalbuminemia, ascorbic acid deficiency and zinc deficiency. Soil pica can affect certain electrolytes (potassium, phosphate and calcium) depending on soil composition and these electrolytes are further exacerbated in ESRD patients. Pica has extreme significance in the nutritional status of patients with kidney disease and should not be neglected in its implications on these patients.