Resolution of chyloperitoneum in a preterm with octreotide, diet and cessation of dialysis.

Abstract

The diagnosis of chyloperitoneum (CP) is based on the presence of high levels of triglycerides (TGs) in the dialysate. It is a rare complication of peritoneal dialysis (PD) and even rarer in neonates. We report here the case of CP in a 1700-g male baby delivered at the 30th gestational week due to posterior urethral valve and associated oligohydramnios. On postnatal day 2, the serum creatinine (Scr) was 1.6 mg/dL, and he was anuric. PD was instituted via a Tenckhoff catheter. At the end of the second week, after the initiation of enteral feeding, the ultrafiltrate became cloudy, with a leukocyte count of 900/mm(3). A treatment regimen consisting of intraperitoneal vancomycin and ceftazidime was then started. Five days later, the fluid became milky, with a TG level of 251 mg/dL. The patient was then placed on a diet based on medium-chain triglycerides and octreotide (1 microg/kg/h; increasing up to 2 microg/kg/h over 15 days). Although the TG and leukocyte levels decreased, the milky appearance persisted. PD was stopped for 2 days when the Scr decreased to 1.7 mg/dL. When it was resumed, the fluid was totally clear, with a TG level of 7 mg/dL. The infant was discharged with a nightly intermittent peritoneal dialysis program and has had no recurrence. In summary, we report a preterm infant who developed CP during PD and recovered following treatment that included diet modification, octreotide, and temporary discontinuation of the PD.

• Authors: Alper Soylu, Demet Alaygut, Didem Yeşilirmak, Belde Kasap, Mehmet Türkmen, Nuray Duman, Salih Kavukçu
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 25 Issue 2 Pg. 363-6 (Feb 2010) ISSN: 1432-198X [Electronic] Germany
• PMID: 19902268 (Publication Type: Case Reports, Journal Article)

Chemical References

• Dietary Fats
• Gastrointestinal Agents
• Triglycerides
• Octreotide

Topics

• Chylous Ascites (diet therapy, drug therapy, pathology)
• Dialysis
• Dietary Fats (administration & dosage)
• Gastrointestinal Agents (therapeutic use)
• Gestational Age
• Humans
• Infant, Newborn
• Infant, Premature
• Male
• Octreotide (therapeutic use)
• Treatment Outcome
• Triglycerides (administration & dosage)