Negative drain with fluid gain. Help!

[*kana*]

Hi,
I just started back on PD and of course it would have to be a holiday weekend.  My nurse is available but I'm just not ready to bother him at home.  I have no kidneys and been using 2.5% for a couple days.  The problem is is I am not pulling off any extra fluid.  I wake up in the morning with a negative amount and the most I can pull is 400 for the entire day.  I have not had anything to drink in about 48hrs and I am over my dry weight by 5 pounds.  I really didn't drink much to begin with so it is mainly dialysate absorption.   

I am getting by on my supplies from when I was doing PD before and I had them come and get my 4.2% because I had kidneys then and never used that strength.

Please explain why I am absorbing the solution and not able to pull it off?  I am afraid that PD wont work for me now for some reason.  Thank you     

[KICKSTART]

Difficult one , there could be lots of reasons. I hate to say it but you could just have come to the end on PD (this has just happened to me) Im sure that not drinking anything cant be good for you though. It could be any number of things wrong and i could list them all, but i really think if what you say is happening then you need to get medical advice as soon as possible , any delay could further your problems. It took them 3 months to decide my PD has stopped working and by then i was really fluid overloaded and very ill. I would contact your renal unit and let them find out whats going on sooner rather than later. Best of luck ! 

[peleroja]

Are all your boxes current and not expired?  My nurses said under no circumstances use expired fluid.  Any possibility of adhesions within your peritoneum.  I had a nasty problem with those.  Is your machine accidentally set for tidal instead of standard?  That's all I can come up with right now.  Hope you find the answer.

[Jenabcd]

Did you sleep through all of your drains, including the last one of the morning?  I drain the very best when I am upright.  Even this morning, when I woke up, my UF was -36.  Yes, MINUS 36.  I sat up for the last drain, and drained almost 800.  Since I do an afternoon exchange, I also pulled off over 100 then, so I do fine.  I just really have to be up for that last drain. 

[Red from Canada]

It could be fibrin blocking your tube.  Do you use heparin regularly?

[CCStan]

K, Are using cycler or manuals ?  While hubby was on on cycler had mostly negative drains as much as or more than  500ml.  He was in hospital twice with fluid overload.  (when he was on mauals no problems) Tried cycler with dift settings and 4.25 still a lot of negative drains.  We finally convinced nephro to allow us to go to Extraneal and manuals, since then we have been doing fine with fluid ... 24 hrs are always postive now.  He does still put out urine. 

We really think the cycler was the problem.  We will be doing a  kt/v next monday to see how clearance is doing.  But he has been feeling so much better with the switch.(more energy)  Although since it was determined that is is a fast transporter is manuals are dwelling for 2 to 3 hours no longer.  He does the Extraneal for his night dwell and has uf of 300 to 500 on drain.

I must tell you while in the hospital to remove the fluid they were doing 4.25 every hour until the damn broke loose.

Hope this helps.
CCSTAN

[Jie]

What you need is a pet and Kt/V lab to see what is going on. If the PD does not work any more, this lab can show it right away. For negative UF, there are a few things you can check:
(1) drain. How well the cycler does the drain? This can be checked through manual drain. Some days, I did 3 times of manual drain on the morning, varying different sitting positions. The maximum fluid I took out through manual drain is 715 ml. That means my belly can hide that amount fluid from the cycler when I am on sleep position. Normally, I get 200-300 ml out through manual drain each morning.
(2) Dwell time. The maximum UF occurs at about 1 hour of dwell time. Based on the pet result, dwell time should be set properly.
(3) Types of solution. 

[*kana*]

Ok, first off I'd like to thank everyone for their kind and speedy replies.  I called my nurse and he is going to meet me tomorrow and give me some stronger solution 4.2%.  I, however, am very embarressed to admit that after all of this worry on my part, my husband found my problem.  I was using only the 1.5% for the first 2 days and then switched over to only 2.5's but had fluid build up.  It appeared that I wasnt taking off any extra fluid because........uhm, my little scale was 1-1.5# off!  I never knew there was a little adjustment on it and if it isn't set on 1 then it is off.

I still have extra fluid to come off but I am very confident that the 2.5% will be enough to pull it off.  I wont be able to use 1.5% anymore.  Sad

Thank you again for taking the time to reply.  I find you all so helpful!  I just wish my brain would work better and I could have figured out the problem myself.   

[Hanify]

Also it's worth checking that you're not constipated - that can affect your drain.  You might want to also get your albumin checked.  Apparently if you have low albumin levels then it's harder for the fluid to come off you.  You may end up back on yellows - it changes as you go.

[Restorer]

I had the same problem when I was on manuals. I was a high transporter, and the dwell time for manuals (5 hours) was too long - after carrying fluid for 3 hours or so, I started reabsorbing it, and after 4 hours I was into negative UF. You sound like you're on manuals. You might do better on a cycler, or for the time being, increasing your number of exchanges per day to 5 or 6, and decreasing your dwell time to 3 hours or so.

Ask your PD nurse about a PET test and possibly going on the cycler at night, with much shorter dwell times.