Abdominal Pain with Infusion of the Peritoneal Dialysis Solutions Relieved by Alkalinization

Sir: We would like to share with your readers our experience with a patient who developed unexplained abdominal pain during infusion with peritoneal dialysis solut ion. This 50-year-old woman had been on CAPD for one month when she started to complain of severe abdominal pain during the infusion of dialysis solution that contained lactate. The pain, which initially involved the hypogastric area, started after we had infused 400 ml of dialysis solution. The pain abated 10 minutes after the procedure had ended. The pain was not relieved by slowing down the flow rate, varying the temperature of the dialysate, or changing the brand of the solution, or adding xylocaine. The effluent white cell count was normal and there was no eosinophilia. The clearance of the small molecules and the ultrafiltration rate was good. No hypertonic solutions were used. On radiologic and laparoscopic examination, the peritoneal catheter was in place. Because an earlier report in the Perit Dial Bull (Suppl) vol 3, #2 (pg. 26, 1983) had suggested that the low pH of the peritoneal dialysate may be inducing the pain, we alkalinized the solution by adding 10 mEq of sodium bicarbonate to each CAPD bag to achieve a final pH of 7.2. This change eliminated the pain, however such manipulation of the bags increased the risk of infection and eventually our patient had three episodes of staph epidermidis peritonitis over a sixmonth period on sodium bicarbonate whereas during the four months preceding this she had had no peritonitis. Despite this high infection-rate the patient continues on CAPD because she has had problems with vascular access and we were unable to switch her to hemodialysis. We wonder whether any of your readers has had similar experience and whether they could suggest any other solution for our patient's problem.