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Chyle Leak
Kennedy Fitzgerald
Dietetic Intern and M.S. Candidate
Auburn University
• Background
• Fat Digestion & Absorption
• Treatment
• Nutritional Management
Outline • Patient Profile
• ADIME
• Conclusion
• Acknowledgements
• Chyle is a milky, odorless fluid consisting of lymph and
emulsified fat.1
• 200 kcal/L, 30 g/L of protein, 4-40 g/L of lipids
• Rare problem resulting from injury or abnormality of
thoracic duct
• May present as chylothorax or chylous effusion, chylous
Introduction: ascites, chylopericardium or as an external draining
fistula.1
Chyle Leak
Symptoms and Diagnosis:
• Dyspnea, coughing, chest discomfort and/or tachycardia3
• Proposed methods range from chest x-rays to CT scans
of thorax to assessing pleural fluid with respect to color,
composition, and volume
Treatment
• PMH: arthritis, diverticulosis, HTN, stomach ulcers, kidney stones, SOB, chylous pleural
effusion
• PSH: colonoscopy, EGD, kidney stone basket extraction, lithotripsy, recurring
thoracenteses
• Presented in June with SOB and orthopnea
• Initial thoracentesis 6/8 with 2000 mL removed
• TG concentration of 1758 mg/dL
• PET-CT revealed a posterior mediastinal mass extending into the right and left paraspinal
region to the level of aortic hiatus
• Diagnosed with low-grade-B-cell lymphoma, most consistent with marginal zone
lymphoma
• Weekly therapeutic thoracenteses draining 2-3 L of chylous fluid each time
Nutrition Assessment
• Chyle leaks are a complex problem resulting from injury or abnormality of thoracic
duct
• Serious complications including dehydration, malnutrition, and immunosuppression
• JC
• Low-grade-B-cell lymphoma
• Weekly thoracenteses removing 2-3 L of fluid
• Low-fat diet education, Fat-free ONS, Multivitamin, MCT oil is weight loss continues
• Future research to establish guidelines regarding optimal route, nutrient mix, and
duration of nutrition support needed to manage chyle leaks.
Acknowledgments
1. McCray S, Parrish CR. When Chyle Leaks: Nutrition Management Options. Pract. Gastroenterol. 2004;17, 60-
76. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/11/McCray-may04.pdf. Accessed
October 5, 2021.
2. Smoke A, DeLegge MH. Chyle Leaks: Consensus on Management? Nutr Clin Pract. 2008;23(5), 529-532.
https://pubmed.ncbi.nlm.nih.gov/18849558/. Accessed October 5, 2021.
3. Kotze V, Van Schalkwyk N. Medical Nutrition Therapy for a Patient Presenting with a Chylothorax. S Afr J Clin
Nutr. 2013;26(3), 152-155. http://www.sajcn.co.za/index.php/SAJCN/article/view/809. Accessed October 5,
2021.
4. Sriram K, Meguid RA, Meguid MM. Nutritional Support in Adults with Chyle Leaks. Nutrition. 2016;32, 281-286.
https://www-sciencedirect-com.spot.lib.auburn.edu/science/article/pii/S0899900715003378?via%3Dihub.
Accessed October 5, 2021.
5. Karagiania J, Sheean PM. Managing Secondary Chylothorax: The Implications for Medical Nutrition Therapy. J
Am Diet Assoc. 2011;111(4), 600-604. https://jandonline.org/article/S0002-8223(11)00015-0/fulltext. Accessed
October 5, 2021.
References Cont.
6. Bibby AC, Maskell NA. Nutritional Management in Chyle Leaks and Chylous Effusions.
Br J Community Nurs. 2014;19(11), S6-8. https://pubmed.ncbi.nlm.nih.gov/25381927/.
Accessed October 5, 2021.
7. Kalomenidis I. Octreotide and Chylothorax. Curr Opin Pulm Med. 2006;12, 264- 267.
https://pubmed.ncbi.nlm.nih.gov/16825878/. Accessed October 10, 2021.
8. UVA Nutrition: GI Nutrition Support Team. Very Low-Fat Diet for Chyle Leaks.
https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2020/03/Chyle-
Leak-Diet-2-21-20.pdf. Accessed October 5, 2021.
9. St. Joseph’s Healthcare. Fat-Free Diet for a Chyle Leak.
https://www.stjoes.ca/patients-visitors/patient-education/a-e/ChyleLeakFatFreeDiet-
trh%20(2).pdf. Accessed October 5, 2021.