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Etiology PLEURAL FLUID Exudate

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Etiology PLEURAL FLUID Exudate Powered By Docstoc
					PLEURAL FLUID
                                                                Exudate                      Transudate
 Protein                                                         > 3g/dL                      < 3g/dL
                                                                                                                   Procedure                                          Risks
 Pleural fluid : serum protein ratio                                 > 0.5                      < 0.5
                                                                                                                                                           Arterial injury
 Lactate dehydrogenase (LDH)                                   > 200 IU/L                    < 200 IU/L           Arterial line/puncture                   Arterial spasm
                                                                                                                                                           Arterial thrombosis
 Pleural fluid : serum LDH ratio                                     > 0.6                      < 0.6
                                                                                                                                                           Hand injury
Source: Cecil Essentials of Medicine
                                                                                                                                                           Bleeding
                                                                                                                                                           Damage to tendons, cartilage, or nerves
Ascitic Fluid                                                                                                                                              Localized trauma
                                                                                                                      Arthrocentesis
       Portal hypertension related                             Non-portal hypertension related                                                             Re-accumulation of fluid
                SAAG ≥1.1                                                 SAAG<1.1                                                                         Arterial puncture
 Sinusoidal                                                   Peritonitis: tuberculosis (TB), ruptured                                                    Cardiac dysrhythmias
    Cirrhosis (inc. SBP)                                       viscus                                             Central line insertion                   Central venous thrombosis
    Acute hepatitis                                           Peritoneal carcinomatosis                                                                   Hematoma
    Extensive malignancy (HCC or mets)                        Pancreatitis                                                                                Hemothorax
 Post-sinusoidal                                              Vasculitis                                                                                  Pneumothorax
    Right-sided CHF (inc. constriction & TR)                  Hypoalbuminemic states; nephritic                                                           Bleeding
    Budd-Chiari syndrome, VOD                                  syndrome; protein-losing                                                                    Damage to nerve or spinal cord
 Pre-sinusoidal                                               enteropathy                                          Lumbar puncture                        Headache
    Portal or splenic vein thrombosis                         Meigs’ syndrome                                                                             Herniation
    Schistosomiasis                                                                                                                                        Persistent leakage of CSF
Source: Saint-Frances Guide to Inpatient Medicine                                                                                                          Abdominal wall hematoma
                                                                                                                                                           Circulatory dysfunction if large volume
                                                                                                                                                            withdrawn (> 5L)
Cerebrospinal Fluid                                                                                                                                        Hemorrhage
                                                                                                                       Paracentesis
                   Appearance          Pressure               WBC                 Glucose       Total protein                                              Injury to intra-abdominal organs
  Condition          (color)             (cm)              (cell type)            (mg/dL)         (mg/dL)                                                  Persistent leakage of ascitic fluid
 Normal               clear              9-18             0-5 (lymphs)             50-75           15-40                                                   Air embolism
 Bacterial            cloudy            18-30        100-10,000 (polys)             <45           100-1000                                                 Coughing
                                                                                                                                                           Hemothorax
 TB                   cloudy            18-30             <500 (lymphs)             <45            100-200            Thoracentesis                        Injury to intra-abdominal organs
 Fungal               cloudy            18-30             <300 (lymphs)             <45             40-300                                                 Pneumothorax
                                                                                                                                                           Post-expansion pulmonary edema if large
 Aseptic               clear            9-18        <300 (polys-lymphs)           50-100            50-100                                                  volume withdrawn (> 1.5L)
Source: Pocket Medicine

Synovial fluid
               Appearance Viscosity WBCs          Polys    Culture     Glucose    Crystals       Examples
Normal            Clear        High     < 200     < 25% Negative       ≈ serum     -----                          ***In addition to above, all procedures have risks of pain and infection
Non-             Clear,                                                                       OA, trauma, SLE,
                               High     < 2000 < 25% Negative          ≈ serum     -----
inflammatory     yellow                                                                        aseptic necrosis
                                                                                                                  References:
                                                                                              RA, gout,           Informed Consent: Not just a piece of paper
                   Clear-                                                                    pseudogout,          Strogers Hospital of cook County and Rush Medical Center
                                                                      > 25, but   May be
Inflammatory     opaque,       Low      > 2000 ≥ 50% Negative                                seronegative         Toshiko Uchida, MD
                                                                      < serum        +
               yellow-white                                                              spondyloarthropathie     Christine Schaeffer, MD
                                                                                                   s              NEJM clinical videos
                                                                                            TB, bacterial         http://uscneurosurgery.com/infonet/surgery/understand/risks/procedure/aline.htm
Septic           Opaque        Low      >>2000 ≥ 75% Positive           < 25       -----
                                                                                               infection
Source: Washington Manual, Pocket Medicine, Up-to-date

				
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