title: Severe "sweet" pleural effusion in a continuous ambulatory peritoneal dialysis patient.
abstract: BACKGROUND
  Hydrothorax is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) which can progress quickly to cause acute respiratory distress.
  
  
  METHODS
  We present a 76 year-old female with a past medical history significant for end-stage renal disease (ESRD) on daily home peritoneal dialysis for 2 years presented to the hospital from home with shortness of breath at rest and cough for 2 days prior to admission. She developed severe respiratory distress and had emergent pleurocentesis that released 3.8 L of pleural fluid. The analysis showed significantly high sugar indicative of hydrothorax from CAPD. She underwent thoracotomy with pleurodesis and switched to hemodialysis for 6 weeks before resuming CAPD.
  
  
  CONCLUSIONS
  A high glucose concentration in the pleural fluid is pathognomonic for hydrothorax from dialysis fluid after rule out other possible causes of pleural effusion. Patients who are on CAPD presenting with marked pleural effusion should prompt clinicians to consider the differential diagnosis of pleuroperitoneal communications.
authors.affiliation: Department of Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA.
authors.forename: Rapeephan R
authors.initials: RR
authors.lastname: Maude
authors.affiliation: Department of Pulmonary and Critical Care, Saint Vincent Hospital, Worcester, MA, 01608, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Barretti
keywords: Continuous ambulatory peritoneal dialysis; Hydrothorax; Peritoneal dialysis; Pleural effusion; Pleuroperitoneal communication