Bacillus subtilis-associated abdominal catastrophe in a Japanese patient with peritoneal dialysis-related peritonitis

Abdominal catastrophe in patients with peritoneal dialysis (PD) is a condition in which visceral injury may cause leakage of enteric microorganisms into the peritoneal cavity, resulting in peritonitis. A 50-year-old Japanese male, who had been on PD for 5 years, was diagnosed with PD-related peritonitis. The initial peritoneal fluid culture detected Bacillus subtilis and Enterococcus faecalis. Antibiotic treatment was immediately initiated. Abdominal computed tomography (CT) revealed a pelvic abscess and ileus without mechanical obstruction. We consulted with surgeons regarding surgical intervention. Since mechanical obstruction or perforation was not detected in the initial abdominal CT, abscess drainage was recommended. However, the fever recurred. Abdominal CT performed for the seventh time identified a fistula between the sigmoid colon and pelvic cavity. Surgical removal of the colon was performed. Herein, we elucidate a very rare case of Bacillus subtilis-associated abdominal catastrophe and discuss the clinically important aspects of it

A low initial serum sodium level is associated with an increased risk of overcorrection in patients with chronic profound hyponatremia: a retrospective cohort analysis

Abstract Background Even with abundant evidence for osmotic demyelination in patients with hyponatremia, the risk factors for overcorrection have not been fully investigated. Therefore the purpose of this study is to clarify the risks for overcorrection during the treatment of chronic profound hyponatremia. Methods This is a single-center retrospective observational study. We enrolled 56 adult patients with a serum sodium (SNa) concentration of ≤125 mEq/L who were treated in an intensive care unit by nephrologists using a locally developed, fixed treatment algorithm between February 2012 and April 2014. The impact of patient parameters on the incidence of overcorrection was estimated using univariable and multivariable logistic regression models. Overcorrection was defined as an increase of SNa by >10 mEq/L and >18 mEq/L during the first 24 and 48 h, respectively. Results The median age was 78 years, 48.2% were male, and 94.6% of the patients presented with symptoms associated with hyponatremia. The initial median SNa was 115 mEq/L (quartile, 111–119 mEq/L). A total of 11 (19.6%) patients met the criteria for overcorrection with 9 (16.0%) occurring at 24 h, 6 (10.7%) at 48 h, and 4 (7.1%) at both 24 and 48 h. However, none of these patients developed osmotic demyelination. Primary polydipsia, initial SNa, and early urine output were the significant risk factors for overcorrection on univariable analysis. Multivariable analysis revealed that the initial SNa had a statistically significant impact on the incidence of overcorrection with an adjusted odds ratio of 0.84 (95% confidence interval, 0.70–0.98; p = 0.037) for every 1 mEq/L increase. Additionaly, the increase in SNa during the first 4 h and early urine output were significantly higher in patients with overcorrection than in those without (p = 0.001 and 0.005, respectively). Conclusions An initial low level of SNa was associated with an increased risk of overcorrection in patients with profound hyponatremia. In this regard, the rapid increase in SNa during the first 4 h may play an important role

Lower Limb Ulcer Associated with Peritonitis in Patients Undergoing Peritoneal Dialysis

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