Reversible Calcium Channel Blocker-Induced Chylous Ascites in a Pediatric Patient on Peritoneal Dialysis: A Rare Complication

Introduction: Chylous ascites in peritoneal dialysis (PD) is a diagnostic challenge, often mimicking peritonitis. Rarely drug-induced (e.g., by calcium channel blockers—CCBs), recognition is crucial to avoid unnecessary interventions and maintain PD efficacy. We report such a case. Case Description: A 12-year-old male with ESRD on PD developed milky effluent (Figure 1) on CCB therapy (Nifedipine). His PD fluid analysis revealed Normal Cell count, negative culture, high triglycerides (584 mg/dL) and positive chylomicrons (ether extraction), confirming chylous ascites. This impaired PD efficacy (hyperkalemia and uremia) requiring rescue hemodialysis. Other causes were excluded. The CCB was stopped. His PD fluid cleared rapidly in 3 days (Figure 2). Resolution was confirmed by decreasing triglycerides (55 mg/dL) and the absence of chylomicrons. Effective PD was restored; no further hemodialysis was needed. Discussion: CCBs are a rare, reversible cause of chylous ascites in pediatric PD; a unique consideration in this demographic. Chylous ascites mimics peritonitis and can compromise PD adequacy. Rapid resolution on CCB withdrawal is a key learning point; prompt CCB discontinuation prevents unnecessary antibiotics, investigations, and PD cessation.Chylous effluent before discontinuation of CCBAfter stopping CCB