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Discussion

removing dialysis increases temp

A pt is intubated and on continuous dialysis following sepsis from a staph infection. Blood cultures are now clear, WBC wnl. Lungs still fluid filled and pt remains on vent. Pt is getting better but three attempts to stop dialyisis have caused a fever. Why is this...is there another infection despite the normal wbc? I don't understand the connection between removing dialysis and the fever but it happens each time and the pt is returned to the dialysis and the fever goes away.

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    I had a pt like that recently. He was septic from a ruptured gallbladder. Similar scenario. OK so CRRT typically lowers your body's core temp because you are dialyizing a persons 37 degree blood (or in this case 39) in room temperature fluids. Each time we interrupted CRRT, his temp went up. When he no longer needed CRRT, he went to regular dialysis and despite all efforts he eventually died of profound sepsis.

    Your patient either has an underlying infection from a highly resistant organism or a neurologic problem causing dysfunction with thermoregulation.

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    Agree - the dialysis is just masking his fever, by putting all that blood out in the air and dropping his temp artificially. I can't imagine that they are returning him to dialysis to avoid a temperature, surely? If he doesn't need it, they should discontinue, find the source of infection and treat. Perhaps he has a fungal infection that might not show a leukocytosis?

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    Cytokine removal? Dialysis does remove circulating cytokines so maybe enough of these were removed to cause the decrease in temperature.

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