Improvised peritoneal dialysis in an 18-month-old child with severe acute malnutrition (kwashiorkor) and acute kidney injury: a case report

Abstract

Introduction: Severe acute malnutrition is common in developing countries. Children with severe acute malnutrition are prone to complications, including electrolyte imbalance and infections. Our patient was an 18-month-old boy who had severe acute malnutrition (kwashiorkor) and developed acute kidney injury, which was managed with peritoneal dialysis using improvised equipment. This case report illustrates the importance of improvisation in resource-limited settings in providing lifesaving treatment. To the best of our knowledge, this is the first case report on peritoneal dialysis in a child with severe acute malnutrition (kwashiorkor).

Case presentation: We report a case of an 18-month-old Bantu-African Tanzanian boy who had severe malnutrition and developed anuric acute kidney injury. He had severe renal dysfunction and was managed with peritoneal dialysis using an improvised catheter and bedside constituted fluids (from intravenous fluids) and was diuretic after 7 days of peritoneal dialysis, with complete recovery of renal functions after 2 weeks.

Conclusion: Children with severe acute malnutrition who develop acute kidney injury should be offered peritoneal dialysis, which may be provided using improvised equipment in resource-limited settings, as illustrated in this case report.

Figure 1

Suprapubic aspiration catheter modified into a peritoneal dialysis catheter by cutting holes in the distal part of the catheter.

Figure 2

Peritoneal dialysis fluid made at bedside using 250ml of 5% dextrose solution, 750ml of 0.9% normal saline, 40ml of 8.4% sodium bicarbonate, 7.5ml of 10% calcium gluconate, 1000U of heparin, and 250mg of ceftriaxone.