If a PD patient experiences sudden severe chest pain during dialysis, what is the first action?

• A. Stop PD, evaluate for pleuroperitoneal leak and other emergencies
• B. Ignore pain
• C. Increase dialysate volume
• D. Check blood sugar

Answer: (A)

When sudden chest pain arises during peritoneal dialysis, stopping the PD exchange is the top priority. This is because chest pain in this setting often signals a PD-related complication, most commonly a pleuroperitoneal leak. The leak allows dialysate to move into the pleural space, risking pleural effusion or pneumothorax and potentially compromising breathing. Halting PD immediately reduces intraperitoneal pressure and stops further dialysate from entering the chest, which helps limit the progression of the problem and buys time to evaluate and treat.

After stopping PD, assess for life-threatening issues and evaluate for a pleuroperitoneal leak or other emergencies. Monitor vital signs, provide oxygen if needed, review symptoms and physical findings, and obtain imaging (such as a chest X-ray) to look for pleural effusion or pneumothorax. If a leak is confirmed or suspected, plan to switch to another form of dialysis and manage the patient accordingly, while addressing any other causes of chest pain (for example, ischemia) as indicated. Ignoring the pain or increasing dialysate would exacerbate the underlying issue, and checking blood sugar, while important for other reasons, is not the immediate priority in this acute setting.