A white, milky fluid in a pleural space in a patient receiving total parenteral nutrition (TPN) may be either chyle or TPN fluid. A number of laboratory tests can be performed to distinguish between the two.
Patient selection: receipt of total parenteral nutrition (TPN) therapy
Features shared by chyle and TPN fluid:
(1) white and opaque gross appearance
(2) high triglyceride concentration
Features of chyle:
(1) chylomicrons on lipoprotein electropheresis
Features of TPN fluid:
(1) high glucose concentration (multiples of normal)
(2) high potassium concentration (multiples of normal)
If the TPN fluid is available, then its composition should be matched with the fluid.
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