Some say, a methylene blue test, but others say it may cause chemical peritonitis.
Is glucose measurement a reliable test?
What are some other diagnostic tests and how are they performed?
The development of pleural effusion in a patient on peritoneal dialysis, suggests three possibilitities 1. a pleuro-peritoneal leak, 2. underdialysis or presence of CHF, in which case pleural effusion may be bilateral or 3, secondary to an infection or local process, that could be inflammatory or neoplastic.
Of course, clinical history will help differentiate these. A development of a unilateral large pleural effusion of acute onset [after patient started on peritoneal dialysis or after night dwell, when patient is lying down] suggests more so a peritoneo-pleural leak. The drainage of abdomen may decrease the pleural fluid and if patient could be left dry for few days [especially at the start of PD, patient may have enough residual function] and the pleural effusion may clear. This would highly suggest a leak, sudden onset with quick resolution, after withholding peritoneal dialysis - safe, effective and inexpensive solution.
Yes, pleural fluid glucose concentration would be the other test to do this.
You may consider methylene blue or radiolabeled dialysate but often these studies are often not required unless the leak is very slow, that often is not the case.
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