<![CDATA[Introduction: Hypokalemia in peritoneal dialysis (PD) can be caused by dialysate potassium loss, low intake of potassium-rich foods, or gastroenteritis. Hemoperitoneum is a non-mechanical complication of peritoneal dialysis, common in menstruating women. Case: A 52-yearold woman with end stage renal disease (ESRD) on PD was admitted to the emergency department with persistent vomiting and bloody dialysate. The patient had a history of type 2 diabetes, controlled with antidiabetic drugs. Her serum potassium was 2.0 mEq/L. Ultrasound showed simple ovarian cysts and uterine myomas. She was diagnosed with severe hypokalemia, hemoperitoneum, type 2 diabetes, and ESRD. The treatment included oral and intravenous potassium chloride, tranexamic acid, and frequent dialysate changes. After a one-month follow-up, no complications were reported. Discussion: The hypokalemia was likely associated with gastrointestinal potassium loss and inadequate intake of potassium-rich foods. The temporal relationship between menstruation and bloody dialysate, together with the absence of cyst rupture or peritonitis, supported retrograde menstruation as the probable cause of hemoperitoneum. Conclusion: Hypokalemia may result from gastrointestinal losses, inadequate potassium intake, while menstruation might cause bloody dialysate in PD.]]>
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