An adolescent on peritoneal dialysis with acute encephalopathy: questions

Excerpt

A 16-year-old girl with a history of systemic lupus erythematosus (SLE), end-stage renal disease (ESRD) secondary to lupus nephritis on continuous cycling peritoneal dialysis (PD) presented to the emergency department with a 5-day history of upper respiratory symptoms and 3 days of vomiting and diarrhea. A review of her past medical history revealed that she had been started on PD 3 years prior to this admission. Her course on dialysis had been complicated by recurrent flares of her SLE, for which she received intermittent pulses of corticosteroids and mycophenolate mofetil for maintenance immunosuppression. Her lupus autoantibodies were persistently elevated and complement components were always low. She had also started to show behavioral problems in the form of depressed mood and food restriction, for which she was followed by a psychologist. This was accompanied by episodes of acute hypertension secondary to fluid overload and loss of lean body mass. She also had persistent hypokalemia for which she was on potassium chloride supplements; this was also thought to be secondary to her behavioral food restriction. There had been a suspicion of bulimia in the past; however, after further evaluation by a psychologist this was disproven. The patients’ compliance with medications was questionable, and although renal formulas such as Nepro® were prescribed, the patient repeatedly admitted to not taking them on a consistent basis. …