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Chapter 37
Chylothorax and Chylous Ascites
14
Nutrition
Professional
08/30/2016

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Term
How does chylothorax typicall present?
Definition
It typically presents similar to pleural effusion, with milky white fluid removed during thoracentesis
Term
How does chylous ascites present?
Definition
Chylous ascites presents as symptomatic ascites
Term
What is the most common cause of chylous issues?
Definition
Malignancy
Term
What are the most common electrolyte disturbances associated with chyle leak?
Definition
Hyponatremia and hypocalcemia
Term
How does chyle leak affect serum protein levels?
Definition
It can result in reduced serum protein levels
Term
What are the inclusion criteria for conservative treatment of chyle leak? How long should conservative treatment be attempted for?
Definition
Conservative treatment is appropriate for healthy, stable patients. It should be provided for no more than 2 weeks.
Term
What factors indicate the need to progress from conservative measures to surgical intervention in the case of chyle leak?
Definition
  • Excessive chyle output (>500 mL/d in adults or in children by >10 mL/kg/d or >100 mL/d for each year of age) for >5 days
  • Persistent leak of any volume for >2 weeks
  • Nutritional, metabolic, or infection complications
Term
Should patients with chyle leak be initiated on PN or oral diet?
Definition
Most investigators recommend assessing patient's response to an elemental low-fat diet before advancing to PN
Term
What type of diet should be used for chyle leak?
Definition
High protein, little or no LCFAs (<10 g/day)
Term
What type of EN formula should be used in chyle leak patients?
Definition
Elemental low-fat. MCTs can be added as substitute for dietary fat.
Term
Can PN chyle leak patients be placed on clear liquids?
Definition
Yes
Term
What additive can be added to PN to improve chyle leak?
Definition
Octreotide
Term
Are albumin infusions advisable for chyle leak patients?
Definition
No. However, proteins, coagulation factors, and immunoglobulins may be replaced.
Term
How should diet be advanced after chyle leak cessates?
Definition
After cessation of chyle leak, food intake can be reintroduced and restrictions removed (patients typicall advance to low-fat diet)
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