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Type B PD Solution Reaction — ESENeph MCQ

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ModeratePeritoneal DialysisType B PD Solution ReactionESENeph

A 60-year-old woman on PD for 4 years develops type B (slow-onset) reaction to her first use of a new PD solution. She develops chest pain, back pain, and fever 2-3 hours after commencing the exchange. What is this?

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Correct answer: C — Type B reaction to PD solution (non-IgE-mediated complement activation) – associated with certain PD solution formulations; management is stopping the solution, treating symptoms, and switching to an alternative PD solution

Type B (slow-onset) reactions to PD solutions are complement-mediated and present 2-12 hours after exposure. Symptoms include chest/back pain, fever, and sometimes respiratory distress. They are associated with specific solution components or contaminants. Management: stop the offending solution, supportive care, and switch to a different PD solution brand/formulation. Type B reactions are distinct from Type A (acute, within minutes – anaphylactoid) and from PD peritonitis (which has cloudy effluent, elevated WCC, and positive cultures). Documenting the exact solution batch is important for pharmacovigilance.

Reference: ISPD – PD Solution Reactions; ERA-EDTA 2019