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.