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Casos Clínicos
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| NUTRITIONAL SUPPORT AND TREATMENT OF CHYLOTHORAX WITH OCTREOTIDE |
| M. Sirvent Ochando, P. López Villodre Y M. J. Martínez Seguí |
| Nutr Hop. 2010;25(1):113-119 doi:10.3305/nh.2010.25.1.4444 |
 PDF (92,7kb)
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| Abstract |
| 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), fatfree
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. |
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