FAQ - Chylothorax
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What is a MCT diet for chylothorax? My brother has NHL and continues to build up chyle in pleura.?


He has had repeated thoracentesis to no avail. Dr. suggested MCT diet but I know nothing about it. Does anyone have specific infomation?
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An MCT diet, or medium chain triglyceride diet, is one form of a ketogenic diet. A ketogenic diet is one that is high in fat and extremely low in carbohydrate. It is often used to treat epilepsy, but (obviously) has other uses as well, such as in your brother's case of non-Hodgkins lymphoma.

It works by inducing ketosis and its related effects, a condition typically only present in starving individuals. Without getting too technical, in ketosis, the body stops using glucose as an energy source and starts using fat.

Normally we don't want this to happen, but in the case of your brother, it could cause a reduction in chyle buildup because the body would be forced to use the chyle (which is just lymphatic fluid rich in fat and other nutrients) as an energy source.

I have included below in the source information a page with guidelines for a few different ketogenic diets. The page is geared toward the ketogenic diet as a treatment for epilepsy, but the dietary guidelines themselves are the same (the ketogenic diet is the ketogenic diet, regardless of what you are using it for). Hope this helps, and best of luck to your brother.  (+ info)

Persistent Chylothorax?


I am mainly looking for the insight of someone who specializes in cardiac surgery or thoracic duct surgeries.
My son had heart surgery when he was a week old. His right lung was collapsed post op. He went into cardiac arrest 4 hours post op. He was placed onto ECMO (life support) for 6 days. Chylothorax started within a week after ECMO. The chylothorax was first treated with portagen then TPN for two months. During which time 3 separate ligations of the thoracic duct were preformed. All treatments were unsuccessful. He had blood clots in the neck and center chest area from the life support. Steroids were started and discontinued due to infection after 10 days. The outflow of Chylothorax ranged from 500 MLs - 1000 MLs bilateral per day. Respiratory distress was onset three times due to chest tube clogs or in proper drainage. More to Cont.
He remained intubated during his chylothorax due to acute respiratory distress. His left lung was punctured by a chest tube during a attempt to reinsert. His Chylothorax just resolved after 3 months with no apparent reason for resolving. Now, there is a 11month old in the ICU with the exact same scenario. TPN, steroids, poragen, 1 ligation of the thoracic duct the treatments have shown no improvements. Both infants were on ECMO both suffering blood clots. Her output of Chyle per day is around 600MLs she is on month 3 of Chyle. I am convinced the pressures from the blood clots in both children are making it difficult for the thoracic duct to heal. When in the Cath lab they attempted to remove the 11 month old's blood clot without success. Besides from using a shunt or growth hormones what are the other options for treatment?
Both children also had acute kidney failure. My son's liver is enlarged from the prolonged TPN. The 11 month old's liver is only slightly enlarged. Wouldn't you think that if the Chylothorax does not get resolved by TPN to allow the children to have non fat formula like poragen or monagen? So that it doesn't damage their liver.
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This Topic might help you out:

Department of Surgery, Children's Medical Center, University of Virginia Health Sciences Center, Charlottesville 22908.

Between June 1981 and June 1988, we placed pleuroperitoneal shunts in 16 patients for the management of refractory chylothorax on the Pediatric Surgical Service, University of Virginia. The cause of the chylothorax was caval thrombosis from central venous catheters in 5 patients, idiopathic in 3, and mediastinal lymphangioma in 2, and in 6, it developed after a cardiac procedure. Chylothorax in each patient was unresponsive to thoracentesis, tube thoracostomy, and dietary manipulations. A Denver double-valved shunt system is currently employed and is implanted using general anesthesia. Manual pumping is required postoperatively for several months. Twelve (75%) of the 16 patients had excellent results with complete elimination of the chylothorax and resolution of symptoms. In 10 of these 12, the shunt has been removed. Four had an unsatisfactory result: 3 had inferior vena cava hypertension, and 3 were low-birth-weight premature infants. Four patients seen early in this series required revision of the position of the pleural catheter, with successful drainage in each instance. Pleuroperitoneal shunting is a safe, simple, and effective treatment of chylothorax in infants and children. In view of our success in treating chylothorax with these shunts, we recommend early shunting before the development of nutritional or immunological depletion.
Contact the hospital OK.
Wish your family all the best.  (+ info)

My baby has chylothorax - can you help?


My son had a repair to his esophagus (atresia) when he was 5 days old. A chest tube with a suction bulb was placed after surgery. For perhaps a week there was little drainage and what was there was dark and appeared slightly bloody. After a week and a half or so the fluid became clear and yellow and increased to a fair degree. He began leaking from the hole where the tube entered his back, too. You'd go to move him and it would drip out very quickly. After another few days the fluid level increased dramatically, to about 5 ccs per hour. They switched to a gravity drain and that seemed to work just as well until the drain tube was left looped and higher than the surgery site and he started to have trouble breathing because fluid was accumulating in his chest. He was pulling very hard to breathe and his oxygen saturation went When the drain was put in proper position he drained copious amounts very quickly. They then switched to a pluerovac (drain with suction) because they thought he had air on his lung and for the first several hours there was NO drainage at all. The doctor then changed ot the chest tube for a different style (pigtail to straight) and he began draining fluid again, but not to a great degree. By morning he was in respiratory failure. They inserted a needle in his chest and drained 60 ccs in a matter of a few minutes. They replaced the drain with another pigtail drain and stopped the leak at the insertion point so it wouldn't leak out there anymore. For the past several days they've continued to get 5 ccs per hour. Yesterday they began octreotide and today they are starting him on a formula (via g-tube he already has due to a cleft between the esophagus and trachea he was scheduled to have repaired mid-july - he is also on reflux meds - his stomach is very small) that is supposed to be low protein and have a special type of fat and assist with the healing of the leak to the lymphatic channel. Overnight the fluid has increased to 11 ccs per hour. I am at my wit's end because I don't know how to help my baby and, although I trust that the doctors are doing everything they can to help him, it seems there is a lot of head scratching going on. I have questioned the use of a suction drain. It seems to me that if the drain were placed near the leak (and they haven't pinpointed the leak) the suction could inhibit closure or even irritate the leak site. I also have read so much about chyothorax and the use of fat restricted diets and they all mention the fluid being milky. This is NOT milky - it is the color of very yellow urine and very clear. I'm wondering why, if the duct was injured during surgery, why there was no chyle leaking t first and then it began and now it has increased. It is so frustrating to not know what is going on. I ask questions but just don't seem to get thorough answers. They've told me surgical repair for chylothorax is very difficlt and have le us to believe that it is a long shot that surgery COULD fix it. They've told us his best bet is to let some time go by use the medications and diet, and hopefully it will self-repair. We've been told that if it doesn't heal he cannot live with it and he will die. This is too serious a situation for me to have unanswered questions. PLEASE help me understand this better. I would appreciate any info you think could be helpful to us.
When the surgeon came in this morning after being gone for the weekend he immediately cut the suction on the drain and left it to gravity.
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Chylothorax??? Help needed?


My son has just has a heart op, but the nicked his lymph gland now he has what they call a chloyhorax and he is only allowed to eat 3 grams of fat a day for 6 weeks, till it heals up. And i was just wondering if anyone else knows or experienced it as i could really do with some savoury food ideas. All the dietitians gave me were sweet foods and my son is only 3 and don't want him having too much sugar.
Thanks
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Sometimes in heart or chest surgery, a lymph vessel can be injured by surgical instruments. A chylothorax is the build up of a milky white fluid, in the space surrounding the lungs. This makes it difficult to breathe.

Basically, the lungs are surrounded by several layers of a protective lining called the pleura surround the lungs. Fluids can collect between the pleura layers (called the pleural space). A chylothorax happens when the lymphatic system starts leaking chyle fluid into the pleural space.
The fluid pushes on the lung, making it hard to breathe.

The special diet your child has been put on will decrease the amount of chyle thats produced and promote healing. This diet is called a medium chain triglyceride (MCT) diet. Don't worry to much about the sugar content, usually, children who have this complication don’t have to stay on this diet for long. It won't do any harm, include plenty of fruit.

Foods included in the diet are fruits, vegetables, pasta, skim milk, and plain bread (no nuts, fried breads or fatty breads like doughnuts or croissants)
Your son must not eat meat, egg yolks, cheese, milk products and desserts with a high fat content.  (+ info)

Urgent replies please! My cat is dying.?


She is 13, has been to the vet repeatedly and the hospital. Fluid keeps building up in the abdomen and she wont eat or drink hardly at all. It is either cancer or Chylothorax. There is no recovery likely.I love her so much I cant make THE decision. Please help me.
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look just get her put down and honestly it will be one of the hardest things you will do but think of the pain you will spare her, l have had two put two dogs down mother and son and it still hurts me that l did it but they were in a hell of alot of pain and it was crueler to watch them die slowly, good luck  (+ info)


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