How to manage ca pd patient with total WBC count above 20,000 ?

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Anita Roy, Nurse from Kolkata, West Bengal, India asked
How to manage ca pd patient with total WBC count above 20,000 ?

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I think you mean the white cell count of PD fluid exceed 20,000. I would expect this is a genuine peritonitis episode. The patient should have fever, abdominal pain and positive culture. If not, proceed to save a sterile sample for aerobic and anaerobic culture and sensitivity test plus acid-fast bacilli and fungus and commence intraperitonial antibiotics as per your unit’s protocol. Start prophylactic antifungal treatment as well. Monitor white cell count of PD fluid, patient’s response to treatment and reculture if indicated.

Identify cause of peritonitis, or co-existing exit site infection or tunnel infection;
Arrange for hospitalization if patient’s condition is unwell, (probably rather sick with WCC >20,000);
Provide supportive care;
Reinforce patient’s proper bag exchange technique;

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