Complications from Diabetes: A Case Study on Peritoneal Dialysis

Diabetes leads to subsequent complications?

I would like to inquire about the complications arising from diabetes.
My mother was hospitalized on Lunar New Year's Eve due to symptoms of drowsiness, which led us to the emergency room.
Blood tests and cultures revealed she had peritonitis and a urinary tract infection, likely due to her long-term peritoneal dialysis, which has resulted in peritonitis and poor physiological metabolic function.
She has been experiencing persistent fever, and the hospital diagnosed the cause and managed it with medication.
The doctors also recommended switching from peritoneal dialysis to hemodialysis due to the infection.
Despite controlling the infection, her intermittent fever continued.
During her hospitalization, the transition to hemodialysis put a strain on her body, leading to respiratory failure and cerebral hypoxia, and she has not regained consciousness since.
I kindly request the physician's insights to ease my anxious heart and to understand if there were any misjudgments during the medical process.
Thank you.

Bu'an de xin, 30~39 year old female. Ask Date: 2008/04/01

Dr. Xiao Yongxun reply Internal Medicine

Hello,
In response to your question, long-term diabetes can lead to chronic complications, including nephropathy, heart disease, cerebrovascular disease, retinopathy, neuropathy, circulatory system disorders, and periodontal disease.
Almost every part of the body that is nourished by blood vessels can suffer varying degrees of damage due to hyperglycemia.
The elderly lady developed peritonitis as a result of peritoneal dialysis, which is not uncommon in clinical practice.
When vital signs are unstable or clinical conditions are poor, the occurrence of peritonitis may necessitate a switch to hemodialysis, which is medically understandable.
However, in such a critical situation, combined with poor physiological function of various organs, there is a high risk of shock and cerebral hypoxia.
Prolonged hypoxia can lead to hypoxic-ischemic encephalopathy, resulting in irreversible loss of consciousness.
These changes often leave family members shocked and unable to accept the situation, making it difficult for physicians to manage.
The entire disease process, including the emergence and management of complications, involves multiple and complex factors.
It is advisable to calmly discuss the management and prognosis with your attending physician, including the worst-case scenarios.
Personally, I believe that being prepared is a better choice.
Wishing you health,
Dr.
Hsiao Yong-Hsun, Family Medicine Department, Keelung Hospital

Reply Date: 2008/04/01

More Info

I'm sorry to hear about your mother's condition. Managing diabetes, especially in patients undergoing peritoneal dialysis, can be quite complex and may lead to various complications, including infections like peritonitis and urinary tract infections.
Diabetes can significantly impact the body's ability to fight infections due to several factors, including impaired immune response, poor circulation, and neuropathy. In your mother's case, her long-term diabetes and the use of peritoneal dialysis may have contributed to her susceptibility to infections. Peritonitis, which is an infection of the peritoneum, can occur when bacteria enter the abdominal cavity, often through the catheter used for dialysis. Symptoms typically include abdominal pain, fever, and changes in dialysis fluid appearance.

The decision to switch from peritoneal dialysis to hemodialysis is often made when complications arise, such as recurrent infections or inadequate dialysis. Hemodialysis can sometimes be better tolerated in patients with significant infections, as it reduces the risk of further complications associated with peritoneal access. However, this transition can also be challenging for patients, especially if they have underlying health issues.

Your concern about your mother's persistent fever is valid. Fever can indicate ongoing infection or inflammation, and in the context of dialysis, it may suggest that the infection has not been fully controlled. It's crucial for healthcare providers to monitor such symptoms closely and adjust treatment plans accordingly. If your mother was experiencing intermittent fevers despite antibiotic treatment, it could indicate that the infection was not responding to the initial therapy, or there may be other underlying issues that need to be addressed.

In terms of the medical process, it's essential for healthcare teams to communicate effectively and ensure that all aspects of a patient's health are considered. If there were any lapses in monitoring or adjustments to treatment based on your mother's symptoms, it would be important to discuss these with her healthcare team. They can provide insights into the decision-making process and whether any additional interventions could have been taken.

It's also worth noting that patients with diabetes and renal issues often require a multidisciplinary approach to care, involving nephrologists, endocrinologists, and infectious disease specialists. This collaboration can help manage the complexities of diabetes and its complications more effectively.

In conclusion, while diabetes can lead to significant complications, including infections during dialysis, ongoing communication with healthcare providers is crucial. If you have concerns about the care your mother received, consider discussing them with her medical team to gain clarity and ensure that her treatment plan is optimized moving forward. Your mother's health and well-being are paramount, and advocating for her care is an important part of the process.

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