We had a similar problem about 18 months ago, and we measured the amount of
zinc in the fluid ( which if my memory serves me correctly was about 29
umol/l ). These type of enteral feeds have around 2.3mg of zinc per 100ml,
so it should be relatively easy to distinguish between the feed and the
fluid.
The description of the fluid you have been presented with is almost
identical to ours, with a total protein of 22 g/l.
Out of interest, the patient's plasma zinc was measured as 7 umol/l.
I hope this is of some use.
Peter
Peter Howell
Head Biomedical Scientist - Non-Routine Biochemistry & NPT
Medical Biochemistry Department
Wrexham Maelor Hospital
North-East Wales NHS Trust
WREXHAM
Tel : 01978 725252
Fax : 01978 366520
E-mail : [log in to unmask]
-----Original Message-----
From: Dr. T.A. Gray [SMTP:[log in to unmask]]
Sent: 29 October 1999 17:33
To: [log in to unmask]
Subject: Bright ideas required
Our Friday afternoon problem today came from HDU where they have a
guy
with strawberry milkshake in his lungs and peritoneum. The chap in
question is recovering, or trying to, after repair of an abdominal
aortic aneurysm. The question is whether this is chyle from
lymphatics
ruptured during surgery or the enteral feed which has somehow found
its
way unintended through the gut perhaps through an eroding NG tube.
They
have put some dye down the tube and it has stayed in the gut as far
as
they can tell. The fluid, on standing, has a creamy top layer,
middle
layer of faint haziness and red cell layer at the bottom. The
protein
content (25 g/l) is not too far from that of chyle (20 g/l) but also
not
that far from that of the feed (40 g/l). Almost certainly, after
rolling around the peritoneal cavity , the feed, if that is what it
is,
will have changed due to slow "dialysis" against blood, so I can't
rely
on the content of the native feed being similar to that which has
been
sitting in the peritoneum.
The definitive test is probably Apo B48 content but we don't do that
at
weekends (or ever !).
My prejudice is that this is chyle.
Any ideas for easy tests.
Trevor
Dr. T.A. Gray
Department of Clinical Chemistry
Northern General Hospital
Sheffield S5 7AU
0114 271 4309
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