WCN25-4114 PERITONEAL DIALYSIS IN NEPAL – MOTIVATIONS AND BARRIERS

Over the next five days, the patient's acidosis gradually improved, allowing for the discontinuation of PD.Although the acidosis persisted, it did not reach a severity requiring another session of PD.By the sixth day of antioxidant therapy, the acidosis began improving further, but it remained necessary to continue alkali therapy for its management.The patient was eventually discharged with detailed instructions for ongoing management, including antioxidant supplements, folic acid, oral alkali agents, and dietary recommendations to increase the intake of antioxidant-rich foods during weaning.The parents were also advised to avoid medications contraindicated in Glucose 6 Phosphatase Deficiency (G6PD) due to the potential risk of triggering hemolysis.The case was closely followed, and the patient demonstrated stable metabolic parameters and appropriate growth during subsequent follow-up visits.Conclusions: This case highlights the challenges in managing a child with an IEM who developed severe, refractory HAGMA.The condition was initially stabilized using bicarbonate-buffered PD, demonstrating the critical importance of this intervention in complex metabolic crises.However, when the child experienced a sudden deterioration, a second session of PD was required due to the recurrence of life-threatening acidosis.The logistical hurdles of re-initiating PD, including timely access to dialysis resources and managing fluid overload and electrolyte imbalances, were key to the successful stabilization and recovery.This case highlights that the combination of hemolytic anemia with HAGMA in an infant can serve as a vital clue to the presence of this disorder.It also emphasizes the pivotal role of bicarbonate-buffered PD in managing metabolic crises in these infants, particularly in settings where continuous renal replacement therapy (CRRT) is unavailable.CRRT requires specialized expertise, which may not always be accessible, making PD a viable and efficient alternative in critical situations.It is important to note that commercially available dialysates for acute PD typically contain acetate or lactate as buffering agents.In cases of acute liver failure, the conversion of lactate to bicarbonate is often impaired, limiting the effectiveness of these dialysates.We observed that bicarbonate, as a physiological buffer, bypassed the need for metabolic conversion, making it a more logical and effective treatment in our case.The significant diffusion of lactate and bicarbonate during PD, driven by their concentration gradients, ensured efficient lactate removal and bicarbonate delivery without undesirable changes in osmolality or fluid volume.These findings underscore the importance of considering bicarbonate-buffered peritoneal dialysis in similar clinical scenarios, particularly in patients with metabolic acidosis and impaired lactate metabolism, to optimize treatment outcomes and minimize complications.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.