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Abstract: SA-PO721

An Under-Recognized Complication of Chylous Leak: A Case Report of Rapidly Developed Hyponatremia

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Vadpey, Omid, University of California Irvine, Irvine, California, United States
  • Salasnek, Reed, University of California Irvine, Irvine, California, United States
  • Siu, Man Kit Michael, University of California Irvine, Irvine, California, United States
Introduction

Chylous leak is a documented complication of thoracic duct perforation, with co-morbidities including high output volume depletion, hypoalbuminemia, immuno-compromised states, and electrolyte imbalances. Our goal is to demonstrate the importance of adequate and frequent electrolyte monitoring, including serum sodium, as hyponatremia is an overlooked complication that leads to sudden critical clinical statues for the patient. Our case portrays a moderate hyponatremia within 4 days of clinical presentation of chylous thoracic leak.

Case Description

Our case is of a 32 year old male with a past medical history of asthma, presenting after a motor vehicle accident. His course was found to be complicated by recurrent pleural effusions, with bilateral chest tube placement, and high outputs of 5 liters total per day. Chemistry studies demonstrated elevated triglycerides, cholesterol, in concordance with chylous leak, with low fat diet, TPN, midodrine, and octreotide initiation for treatment of the chylous leak. In addition, patient had an intractable headache and nausea, with subsequent development of a hyponatremia as low as 125, with urine sodium <10, urine osmolality of 1100, mOsm/kg, serum osmolality of 267, bicarb of 15, and a Cr of 0.7, at baseline. The clinical picture involved addressing nutrition demands with multi-disciplinary nutrition discussion for enteral feeding regimen, augmented with TPN, increasing salt intake to 3g three times daily, and a bicarb saline infusion to increase solute repletion at rates of 200cc/hr until repeat IR embolization was completed for the thoracic duct laceration. Patient’s sodium was improved within 6 meq each day, with a final sodium of 135, with no residual neurologic symptomatology.

Discussion

Different etiologies lead to chylous leaks, including iatrogenic surgery, malignancy, and trauma. The morbidities associated with chylous leak in our case involved dangerous circulatory complications, with 4-5L of fluid per day needing supplementation, in addition to electrolyte repletion including bicarbonate and sodium. This case report is aimed to raise awareness for early monitoring of electrolyte levels in patients with high output effusions, to carefully monitor sodium, and to consider early consultation for nutrition, and diagnostic studies, to guide punctual clinical management.