While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:

In peritoneal dialysis, the dialysate fluid that drains from the abdomen should normally be clear and pale yellow. Cloudy, white, or opaque effluent with a strong or foul odor is a classic warning sign of peritonitis — an infection of the peritoneal cavity. Peritonitis is the most serious and most common complication of peritoneal dialysis, often caused by bacteria introduced through the catheter or tubing. The cloudiness results from an influx of white blood cells (primarily neutrophils) into the dialysate as the body attempts to fight the infection. If untreated, peritonitis can progress rapidly to sepsis and is potentially life-threatening. Bladder erosion would not produce cloudy dialysate effluent and is not a recognized complication of this procedure. Excess sugar in the dialysis solution would not cause cloudiness or odor and is a controllable parameter of the dialysate formulation. Bowel perforation can occur but is a less common complication, and its presentation typically involves feculent or brown-tinged fluid rather than white, cloudy fluid. The nurse must report this finding immediately, obtain a dialysate specimen for culture and cell count, and anticipate antibiotic therapy, as prompt treatment is essential to preserving peritoneal membrane function and preventing systemic sepsis.