“Let’s Talk About Peritoneal Dialysis” Post 7: My Effluent Looks Like Milk

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Hey doc, my effluent looks kinda like milk…would it taste good with cookies?

Chyloperitoneum is a rare cause of cloudy or even outright white milky effluent.   This classic appearance is due to the presence of chylomicrons in a triglyceride rich effluent.   

The diagnosis of chyloperitoneum is interesting in that a trained practitioner can reliably diagnose the condition simply from the appearance of the effluent alone.  Confirmation can be obtained by measurement of triglyceride levels in effluent and serum, with higher levels in the effluent being diagnostic.  Some use levels of 110 mg/dl and 200 mg/dl to define chyloperitoneum.

The differential diagnosis of the etiology underlying chyloperitoneum includes trauma, malignancy (lymphoma in particular), cirrhosis, tuberculosis, radiation, sarcoidosis, retroperitoneal fibrosis, pancreatitis, lymphatic obstruction, and medication induced (calcium channel blockers) having been implicated in the literature.

Treatment is targeted at the underlying cause.  A low fat diet decreases lymphatic flow and can be an effective adjunct allowing for spontaneous repair of the lymph leak.   Octeotride has also been shown to be useful in therapy in case reports.

Post by: Ankur Shah, MD (@NephroShah)
Nephrologist, Brown University

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