PD Patient Puffier & Puffier

Our disabled man started PD last Monday. It is Sun. eve. and he is just getting more and more swollen looking…his feet…today his legs are big…swollen looking. We played at a park tonight and he is wheezing and short of breath…not normal for him. What can I do? Soon he will resemble the Pillsbury Dough Boy or Michalin Tire Man! :?

Did you call his PD nurse and ask? Sounds like he might need to use the stronger solution to pull off more fluid. He does CCPD, right? He might also be absorbing the fluid and need shorter dwell times. I’d call the nurse and ask if I were you.

The oncall nurse just called back. We are going with the 4.5 solution. She will talk with the nephrologist tomorrow AM we may have him cycle again tomorrow afternoon …an extra cylce…then his regular night cycle. Yes CCPD. The nurse said he may need the stronger solution all the time. He just came off of 11 years of Hemo. She also said that the nephrologist may want him to come down tomorrow for evaluation, maybe not…we will see. She said do not panic, this does not mean that PD will not work for him.

When he does his CCPD exchanges, how much fluid does the machine remove? Is it more than the amount of fluid that he puts in?

Does your man know what his fluid limit is? Does he understand that he needs to limit his salt and fluids since salt can make someone thirsty and want to drink too much? Drinking too much makes it hard for dialysis to remove the extra fluid which leads to swelling. Does he know tricks he can use to avoid drinking too much? You can read tips on the Life Options website at www.lifeoptions.org/stories/stories.php.

Did the dialysis clinic do a peritoneal equilibration test when your man was in training for PD? This test shows whether someone should do longer or shorter exchanges based on how quickly their peritoneal membrane transports wastes and fluid. Here’s a description of the test:

How is his protein intake. If he’s not eating enough protein (this should show up in his lab tests for albumin), he could developing swelling. Here’s a brochure by the National Kidney Foundation on Diet and Peritoneal Dialysis.

If I were you, I’d ask whether using high sugar solution could be a problem long-term. I’ve heard that it can make people gain weight unless they greatly restrict other sugars in their diet and it can scar the peritoneal membrane. I’d ask what else you could do to help him keep his fluid gains down and/or remove more fluid.

Wow! I do not believe they did the equalibrium test. During mid day of the 2nd day training he did not want to get rehooked up and had one of his behavoral outbursts. So on day 3 of training I came without him. I regulate his fluids and food for the most part…he is not that high functioning to do that. We are giving him another full 7+ hour treatment today per the Dr.'s response with the 4.25 solution. Then he will also have his regular treatment tonight. He is small and a dwarf so he only gets 1 liter at a time. Each treatment is 5 exchanges and takes a bit over 7 hours. The PD nurse said that is not a lot of solution going in and dwelling at one time.
His blood work was excellent according to the PD nurse and nutritionist.
I am taking him Wed. to see the nephrologist.
With the 4.25 his net UF is about 1500. With the 2.25 it was about 450.

Cool, he just came off the daytime extra treatments and had a UF net of 1850! He looks a bit better :slight_smile:

Glad to hear it. Hope he keeps getting off the extra fluid. I’m sure it’s pretty uncomfortable. I’d make a list of questions to ask the nephrologist when you see him/her about the fluid and what options there are to get it off and keep it off.