Purpose. A case of eosinophilic peritonitis (EP) with severe cardiovascular compromise in a patient receiving intraperitoneal vancomycin therapy is described.Summary. A woman with a medical history including hypertension, endstage renal disease, and anemia of chronic disease was hospitalized for complaints of severe abdominal pain and loss of appetite over the preceding four days; she had been undergoing peritoneal dialysis for about one year. Bacterial infection was diagnosed on the basis of peripheral blood and peritoneal fluid analyses showing highly elevated neutrophil and total nucleated cell (TNC) counts. Vancomycin was added to the peritoneal dialysis bags, with subsequent dramatic TNC and neutrophil reductions over two days, but the woman's condition continued to worsen; she developed severe hypotension and on hospital day 13 was transferred to the intensive care unit for central line placement and vasopressor support. The clinician team determined that conversion from bacterial peritonitis to EP had occurred. After the exclusion of other potential causes of EP (e.g., a reaction to dialysis equipment, antihypertensive medication use), intraperitoneal administration of vancomycin was deemed to be the probable cause. Within days of discontinuation of vancomycin use, the patient's hypotension abated, her abdominal symptoms resolved, and she was discharged home. In this case, the diagnosis of EP was complicated by the initial presentation of bacterial peritonitis (confirmed by laboratory and culture data). A literature search identified one other published report of vancomycin-induced EP.Conclusion. A 37-year-old woman developed EP after receiving vancomycin intraperitoneally. The infection resolved after discontinuation of vancomycin.

Purpose: Sucroferric oxyhydroxide is the newest phosphate binder to receive US Food and Drug Administration approval for patients on dialysis. The purpose of this review is to critically evaluate the studies that have been conducted with this medication and determine where it may fit in the clinician's overall treatment plan for hyperphosphatemia in patients with chronic kidney disease.Methods: Literature searches were performed in the PubMed database and www.ClinicalTrials.gov using the search terms sucroferric oxyhydroxide, and PA21 phosphate binder. Limits were set to include only clinical trials performed in human subjects.Findings: Four completed clinical trials and 3 ongoing studies were identified. Completed clinical trials included Phase I, Phase II, and Phase III studies that all demonstrated the ability of sucroferric oxyhydroxide to lower serum phosphorus concentrations. One study compared sucroferric oxyhydroxide with sevelamer and reported no statistically significant difference in serum phosphorus lowering ability. The ongoing trials are evaluating sucroferric oxyhydroxide for long term use, in peritoneal dialysis patients, and compared with calcium-based phosphate binders.Implications: Sucroferric oxyhydroxide is an effective phosphate binder for chronic kidney disease patients receiving hemodialysis and may offer an advantage in terms of pill burden. Gastrointestinal side effects are similar to those of current phosphate binders. Advantages of other phosphate binders (ie, the lipid- and uric acid lowering abilities of sevelamer) may outweigh the pill burden benefits of sucroferric oxyhydroxide. (C) 2014 Elsevier HS Journals, Inc. All rights reserved.