Peritonitis Case Summary

To reduce further renal dysfunction in patient BB, the physician should implement the following recommendations of evidence-based guidelines. Intravenous albumin (1.5 g/kg within 6 hours of spontaneous bacterial peritonitis (SBP) diagnosis and 1 g/kg on day 3) should be given along with intravenous antibiotics. Multiple studies have shown IV albumin effective in decreasing the incidence of renal dysfunction from 33% to 10% and mortality from 29% to 10% and is especially beneficial for patients with baseline serum creatinine ≥ 1 mg/dL, blood urea nitrogen (BUN) ≥ 30 mg/dL.1 Patient BB has a baseline serum creatinine level of 1.3 mg/dL and BUN level of 32 mg/dL. Therefore, IV albumin will help prevent further renal dysfunction. Pentoxifylline, …show more content…
To prevent future episodes of spontaneous bacterial peritonitis, the physician should do the following at discharge. Firstly, patient BB should be prescribed prophylactic antibiotics. Norfloxacin 400 mg PO should be taken daily to prevent recurrence of SBP. Studies have shown that there is a reduction of the probability of SBP recurrence from 68% to 20%.3 Patient BB fits the inclusion criteria for continuous prophylactic antibiotic therapy, by having serum creatinine ≥1.2 mg/dL and BUN ≥25 mg/dL.2 Liver transplantation should also be considered as a possibility to increase chances of long-term survival. Daily norfloxacin should be continued indefinitely or until liver transplantation to prevent colonization and infection by resistant flora.3 Norfloxacin is also shown to reduce the risk of development of hepatorenal syndrome by decreasing the risk of renal dysfunction.2 In addition, patient BB is currently taking pantoprazole 40 mg PO daily. Current practice guidelines recommend that cirrhosis patients should not use proton-pump inhibitors (PPIs) without a significant clinical indication. Many studies have shown evidence that the use of PPIs in cirrhosis patients cause an increase in the risk of developing SBP.2