Presentation and Status in Health Basket
6 bags X 1500 ml
4 bags X 2000 ml
4 bags X 2500 ml
2 bags X 5000 ml
4 bags X 6000 ml
Unless otherwise prescribed, 2000 ml of solution are infused per treatment. If at the beginning of treatment, pain due to abdominal distension occurs, the dose per treatment can be temporarily reduced to 500 – 1500 ml.
Children should be given doses between 500 and 1500 ml (30 – 40 ml/kg body weight) per treatment, depending on age, height and weight.
In large adults and/or patients who tolerate a larger filling volume, even 2500 or even 3000 ml may be used. If the dose is given by a machine as in intermittent or continuous cycling peritoneal dialysis, the use of larger volume bags is recommended.
For full details see prescribing information.
Chronic renal failure being maintained on peritoneal dialysis.
For these specific solutions: For CAPD/DPCA 2, 3 and 4: hypokalaemia, hypercalcaemia. For CAPD/DPCA 3 additionally: hypovolaemia, arterial hypotension. For peritoneal dialysis in general: Peritoneal dialysis must not be commenced in the presence of one or more of the following diseases:
– Diseases which have an effect on the integrity of the abdominal wall or of the peritoneal cavity, such as: recent abdominal injury, abdominal burns, other extensive inflammatory conditions of the abdominal skin (dermatitis) in the region of catheter exit site, peritonitis; abdominal perforation; a history of abdominal operations with fibrous adhesions, inflammatory bowel diseases (Crohn’s disease, ulcerative colitis, diverticulitis), intra-abdominal tumours, recent abdominal surgery, ileus, abdominal hernias; internal or external abdominal fistulae; – Pulmonary diseases, especially pneumonia; – Sepsis; – Laktacidosis – Cachexia and extreme weight loss, particularly when adequate nutrition is impossible; – In rare cases of uraemia which can no longer be managed by peritoneal dialysis; – Extreme hyperlipidaemia – In patients who are physically or mentally incapable of performing peritoneal dialysis as instructed by the physician.
Electrolyte imbalance, e.g. caused by vomiting or diarrhoea, may necessitate the temporary use of a potassiumcontaining peritoneal dialysis solution. In hypercalcaemia, e.g. resulting from high doses of calcium-containing phosphate binders and/or vitamin D, a temporary or permanent change to a solution with a lower calcium content may be necessary. The treatment volume should be reduced in children, according to age, height and body weight. In the elderly, the increased incidence of hernias should be considered before beginning treatment.
Exact records of fluid balance and body weight must be kept to avoid dehydration or hyperhydration with potentially life-threatening consequences. Regular monitoring of physical findings, electrolytes, creatinine and urea concentrations, serum protein, the level of blood sugar and if necessary, other laboratory parameters (e.g. blood gases, acid-base balance) is also essential. In diabetics, the daily insulin dose must be adjusted to take account of the increased glucose uptake. Regular checks on blood glucose are therefore required.
Aseptic conditions must be maintained during dialysate exchange in order to reduce the risk of infection. Plastic containers may occasionally become damaged during transport from the manufacturer to the dialysis centre or during storage in the hospital. This can result in fungiform or bacterial contamination, with growth of micro-organisms in the dialysis solution. All containers should therefore be carefully inspected for damage prior to connection and use of the solution for peritoneal dialysis. Any damage, however minor, to the closure, container welds or corners, must be noted, because of possible contamination. Bags with cloudy contents must never be used. Only use the peritoneal dialysis solution if the container and closure exhibit no signs of damage. The material should be set aside for examination, including a bacteriological investigation, if necessary. Only use CAPD/DPCA 2, 3 and 4 if the solution is clear and the container is undamaged. Any unused portion of the solution is to be discarded. The peritoneal dialysis solution CAPD/DPCA 2, 3 and 4 is not to be used for intravenous infusion.
CAPD/DPCA 2, 3 and 4 is a solution of electrolytes whose composition is essentially similar to that found in human blood.
Possible side effects may result either from the technique of peritoneal dialysis itself or may be induced by the dialysis solution.
Undesirable effects of the procedure: Very common complications of any peritoneal dialysis therapy, including CAPD/DPCA 2, 3 and 4, are peritonitis and infections of the catheter exit site and tunnel. Untreated peritonitis can lead to sepsis. Symptoms of an incipient peritonitis are cloudiness of the dialysate, abdominal pain, and fever. Pathogens and white blood cell count in the dialysate must be determined; lack of any elevation in leukocytes does not necessarily exclude peritonitis if other symptoms are present. It is essential to institute treatment (intraperitoneal and/or systemic) without delay, being in accordance with the latest state of scientific knowledge and using agents effective against the presumed pathogen, even before culture results are available. Once these are known, therapy should be adjusted appropriately.
A relative loss of proteins (5 – 15 g/day) and amino acids (1.2 – 3.4 g/day) is unavoidable, likewise water-soluble vitamins may also be lost. A deficiency of these substances must be countered by adequate dietary intake. Hypoproteinaemia may occur if protein intake does not compensate for the protein loss. The transport characteristics of the peritoneal membrane may change during long-term peritoneal dialysis primarily indicated by a loss of ultrafiltration. In severe cases peritoneal dialysis must be stopped and haemodialysis commenced.
In addition, distension and a feeling of fullness (abdominal complaints), in- and outflow disturbances of the dialysis solution, hernia, pain in the shoulder, dyspnoea due to elevation of the diaphragm, diarrhoea, and constipation may occur.
Undesirable effects of the solution:
The dialysis solution may cause fluid and electrolyte imbalance, e.g. hypokalaemia.
Hypercalcaemia can occur if calcium intake is increased, e.g. through concomitant use of calcium-containing phosphate binders. These electrolyte disorders can be corrected by changing to other peritoneal dialysis solutions (hypercalcaemia) or a changed diet (hypokalaemia).
In terms of fluid balance, dehydration or hyperhydration may develop. Severe dehydration, (especially on treatment with solutions of higher glucose concentration) may take the form of low blood pressure, increased heart rate, dizziness and muscle cramps; the opposite, hyperhydration, may cause increased body weight, high blood pressure, swollen legs and shortness of breath. Disorders of lipid metabolism (dyslipoproteinaemia and hyperlipidaemia) may occur or be exacerbated. Because of the continuous uptake of glucose from the dialysis solution obesity might rarely occur if the diet of the patient is not adapted to the increased caloric load.
As a general principle, it should be borne in mind that medication given concurrently might pass into the peritoneal dialysis solution and be lost from the body; hence its dosage may require adjustment. The possibility of hypercalcaemia should be considered on concomitant administration of calcium compounds or vitamin D. Simultaneous administration of diuretics may be worthwhile to support residual excretion by the kidneys, but can also cause disturbances of fluid and electrolyte balance. Potassium levels must be monitored particularly closely during concurrent digitalis therapy, as the sensitivity to these drugs is increased in patients with hypokalaemia.
Pregnancy and Lactation
Peritoneal dialysis treatment should only be carried out in the later stages of pregnancy after careful weighing of the benefits and risks.
To date, no emergency situations specific to this solution have been reported. Excessive inflow of dialysis solution can be easily drained into an empty bag. If however, bag exchanges have been carried out too frequently, states of dehydration and/or disorders of blood electrolyte content (electrolyte imbalance) can occur. If an exchange has been forgotten, then as a rule the dwell times of the next bags should be reduced in such a way that the total amount of dialysis solution required per day (e.g. 4 x 2000 ml) is still achieved. Incorrect balancing can lead to hyper- or dehydration and electrolyte disturbances. The most likely consequence of an overdose with CAPD/DPCA 2, 3 and 4 is dehydration. Underdosage or discontinuation of treatment can lead to life-threatening hyperhydration with peripheral oedema and cardiac decompensation and/or other symptoms of uraemia, which may endanger life. The generally accepted rules of emergency and intensive medicine are applied. The patient may require urgent haemodialysis.