Peritoneal dialysis (PD) fluid is easily accessible in patients treated with PD and is routinely used to assess peritoneal membrane transport characteristics and to diagnose peritonitis. We report a case of a 45-year-old man with a medical history of cocaine use who developed oliguric end-stage renal disease due to antineutrophil cytoplasmic antibody–associated vasculitis that was attributed to cocaine and levamisole exposure. After starting PD therapy, the patient presented to the emergency department with volume overload and severe hyperkalemia due to nonadherence to his PD prescription.