CCPD (last fill only 500ml for day dwell)pt had shoulder pain and felt due ot air in line, assessment of effluent clear per pt. I feel poss. slightly hazy (not a for sure cloudy)(hard for me to tell due to only 500ml in drain bag) pt off and on reports abdomen soreness only mild. PD Cell count noted WBC 219 with neutrophils only 10. Lymphs 6, eosinophils 0, Mesotheial cells 8, and monocytes 76. Pt still working and not affected by it. Treating her as if she has peritontis but does she really. Do I count this as an infection. Gram stain and cultures with no growth after one day. She is not a diabetic. I was also wondering about the elevation in monocytes instead of the neutrophils. Please advise. Thanks!

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Carla M., Nurse from Canton, GA asked
CCPD (last fill only 500ml for day dwell)pt had shoulder pain and felt due ot air in line, assessment of effluent clear per pt. I feel poss. slightly hazy (not a for sure cloudy)(hard for me to tell due to only 500ml in drain bag) pt off and on reports abdomen soreness only mild. PD Cell count noted WBC 219 with neutrophils only 10. Lymphs 6, eosinophils 0, Mesotheial cells 8, and monocytes 76. Pt still working and not affected by it. Treating her as if she has peritontis but does she really. Do I count this as an infection. Gram stain and cultures with no growth after one day. She is not a diabetic. I was also wondering about the elevation in monocytes instead of the neutrophils. Please advise. Thanks!

1 answer

So your patient has mildly elevated PDF WCC which is predominated by monocytes. The differential diagnosis are tuberculous peritonitis, and chemical periotnitis caused by icodextrin or other substances. I suggest you should send the effluent of the longest dwell for AFB smear and culture +/- PCR for AFB. Check whether she is using icodextrin or intraperitoneal additives.If yes, please see if the WCC would decrease if stopped for a week.

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