Nutritional support and treatment of chylothorax with octreotide

• Published in: Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral Vol. 25; no. 1; pp. 113 - 119
• Main Authors: Sirvent Ochando, Mariola, López Villodre, P, Martínez Seguí, M J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-01-2010
• Subjects: Chylothorax - diagnostic imaging; Chylothorax - drug therapy; Chylothorax - therapy; Gastrointestinal Agents - therapeutic use; Humans; Male; Malnutrition - etiology; Malnutrition - therapy; Middle Aged; Nutritional Support; Octreotide - therapeutic use; Parenteral Nutrition; Plasminogen Activators - therapeutic use; Radiography; Urokinase-Type Plasminogen Activator - therapeutic use
• ISSN: 0212-1611
• DOI: 10.3305/nh.2010.25.1.4444

Patients with chylothorax present a high risk for malnourishment since continuous loss of chylo leads to a significant impairment of their nutritional status. Chylothorax treatment, which initially is conservative, includes dietary measures and medications such as octreotide that decreases chylothorax flow. In this paper we present the case of a patient with chylothorax treated by means of pleural drainage, parenteral nutrition, and octreotide, and we review the most appropriate nutritional support as well as the efficacy and safety of octreotide in chylothorax therapy. The types of nutritional intervention that may be done are a low-fat diet supplemented with intermediate-chain triglycerides (ICT), fat-free enteral nutrition or EN with a high percentage of ICT, and parenteral nutrition. There is no consensus on which is the most appropriate measure. We found very few comparative studies, and the literature is based on single cases or case series. Some authors consider parenteral nutrition as the first choice, whereas others recommend starting with a specific diet and using parenteral nutrition only in specific cases. Parenteral nutrition must cover the patient's demands together with compensating the protein and energy losses due to chylothorax. The use of lipid emulsions is no contraindicated since they do not reach the lymphatic system. With regards to EN, the formulations may be lipid-free or with low lipid content. There is no agreement on when to start them once the drainage of chylo decreases. There are cases and case series indicating that octreotide use in chylothorax seems to be safe and effective. There is no consensus on when to start the therapy, the most appropriate dose, or the time to withdraw the treatment.