Resuming peritoneal dialysis after secondary embedding of the peritoneal dialysis catheter in the end-of-life period: A case report.

Secondary embedding of a peritoneal dialysis (PD) catheter has been performed for patients whose kidney function has improved enough to stop dialysis but recovery is not expected to be long term. In addition, we have also performed the procedure for patients who have poor general condition due to severe cerebrovascular and/or cardiac disease or who wish to have PD again at the end of life. Here, we report the case of the first terminal haemodialysis (HD) patient who resumed PD using a secondarily embedded catheter as an end-of-life choice. The patient had undergone secondary embedding of a PD catheter and had been transferred to HD, during which time multiple pulmonary metastases of thyroid cancer were observed. She hoped to resume PD in the end-of-life period, and the catheter was subsequently externalised. The catheter was used immediately, and the patient has continued on PD over the past 1 month without infectious or mechanical complications. For elderly end-stage kidney disease patients with progressive disease and cancer, secondary embedding of the PD catheter may be an option to permit them to live the remainder of their lives at home.

Ceftriaxone-Related Encephalopathy in a Patient With End-Stage Renal Disease and High Ceftriaxone Concentrations in Cerebrospinal Fluid and Plasma: A Case Report.

Ceftriaxone (CTRX) does not require dose adjustment based on the renal function status and is used to treat infections. Recently, several studies reported the incidence of antibiotic-associated encephalopathy due to CTRX in patients with end-stage renal disease (ESRD). We experienced a case of CTRX-related encephalopathy in a patient on hemodialysis. When CTRX-related encephalopathy was discovered, the CTRX concentrations were measured in the blood and cerebrospinal fluid (CSF). The highest blood and CSF CTRX concentrations in this patient were 967 and 100.7 µg/mL, respectively, which were approximately 10 times higher than the CSF concentrations in a previously evaluated patient with CTRX encephalopathy. The concentration of CTRX may be increased in patients with ESRD. Hence, encephalopathy must be suspected in this patient group when CTRX is used.

Tonicity Matters, Especially in Complex Hyponatremia Resulting from Pseudo-, Trans-locational, and True Hypotonic Hyponatremia: An Educational Case Report.

Serum tonicity is defined by the serum concentrations of sodium (sNa) and glucose, which can promote free water movement across intra/extracellular compartments. Rapid changes in serum tonicity can cause brain damage. We herein report an educational case of a patient with hyponatremia (sNa: 112 mEq/L) concomitant with acute alcoholic pancreatitis. The cause of hyponatremia was considered complex. Pseudo- and trans-locational natremia was secondary to hyperglycemia (721 mg/dL) and hypertriglyceridemia (1,768 mg/dL), respectively, and true hypotonic hyponatremia. Regarding sNa correction, rapid correction was suspected. However, this was safely managed by monitoring tonicity (not sNa or osmolarity), thereby avoiding brain damage.