DrVirgo
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Pleural Effusion:
-takes about 300cc to flatten out the costophrenic angle
*LDH (E) <200
*LDH (E/S) <0.6
*PROTEIN (E/S) <0.5
ALL 3 criteria MUST be fulfilled à it is Transudative Effusion.
If 1criterion is not met à Exudative Effusion.
What about pH
Glucose?
LOW pH and LOW Glucose in Exudates, but I can't find the exact values....
HELP!
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| cirus
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in exudate PH will be acidic, & a level of < 7.2 is an indication for drainage without even looking on the other labs..
In transudate the PH will be as serum..
Hope that helps
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| DrVirgo
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Thanks,
and Glucose levels? 
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| cirus
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For transudate-->normal
For exudate---> Markedly decreased in Bacterial infections ( it is typically as CSF)
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| DrVirgo
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Excellent! Thanks.
I found:
Glucose is decreased with cancer, bacterial infections, and RA.
Also:
The most common causes of transudative pleural effusions in the United States are left ventricular failure, pulmonary embolism, and cirrhosis (causing hepatic hydrothorax), while the most common causes of exudative pleural effusions are bacterial pneumonia, cancer (with lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural effusions), viral infection, and pulmonary embolism. Although pulmonary embolism can produce either transudative or exudative pleural effusions, the latter is more common.
And something else which is interesting:
Transudative and exudative pleural effusions are differentiated by comparing chemistries in the pleural fluid to those in the blood. According to a meta-analysis, exudative pleural effusions meet at least one of the following criteria [1]: Pleural fluid protein >2.9 g/dL (29 g/L)Pleural fluid cholesterol >45 mg/dL (1.16 mmol/L)Pleural fluid LDH >60 percent of upper limit for serum
Previously criteria proposed by Light for an exudative effusion are met if at least one of the following exists (Light's criteria) [2]:
- The ratio of pleural fluid protein to serum protein is greater than 0.5
- The ratio of pleural fluid LDH and serum LDH is greater than 0.6
- Pleural fluid LDH is more than two-thirds normal upper limit for serum
Do we have to know the NEW criteria????
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| gr8doc
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Excellent Job Guys. !!!!
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| cirus
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I swear I read the values 4 times & wasn't even able to understand them , God my RAM is full, but no, I don't think we should know them as long as u know the normal serum values, i guess ull be ok..
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| DrVirgo
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I KNOW! I'm saturated too!!
Just remember Exudate: HIGH PROT, HIGH LDH, and HIGH Cholesterol.
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| DrVirgo
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Bumping this one up again...
some good info.
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| docnikki
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hey thts good info. thanks.
there is a difference between exudate and empyma.
I think the following criteria is for exudate /transudate distinction.
- The ratio of pleural fluid protein to serum protein is greater than 0.5
- The ratio of pleural fluid LDH and serum LDH is greater than 0.6
- Pleural fluid LDH is more than two-thirds normal upper limit for serum
When we have to decide whether an empyema has formed from the exudate the prot, glu chol and Ph come into play.
from Ck UW- Empyema= 1) ph <7.2 2) Glucose <40 3) Prot <2.5g/dl 4)LDH>1000 IU/dl
4) WBC >500
Now only the prot differe from yours which is 2.9 and chol is not included in this criteria of ck UW.
But in general..in deciding trans/Exud remains the same..
but to diagnose empyema..low gluc, low prot, high LDH high chol and LOW ph!
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| mjl1717
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DrVirgo wrote:Excellent! Thanks. I found: Glucose is decreased with cancer, bacterial infections, and RA. Also: The most common causes of transudative pleural effusions in the United States are left ventricular failure, pulmonary embolism, and cirrhosis (causing hepatic hydrothorax), while the most common causes of exudative pleural effusions are bacterial pneumonia, cancer (with lung cancer, breast cancer, and lymphoma causing approximately 75% of all malignant pleural effusions), viral infection, and pulmonary embolism. Although pulmonary embolism can produce either transudative or exudative pleural effusions, the latter is more common. And something else which is interesting: Transudative and exudative pleural effusions are differentiated by comparing chemistries in the pleural fluid to those in the blood. According to a meta-analysis, exudative pleural effusions meet at least one of the following criteria [1]: Pleural fluid protein >2.9 g/dL (29 g/L)Pleural fluid cholesterol >45 mg/dL (1.16 mmol/L)Pleural fluid LDH >60 percent of upper limit for serum
Previously criteria proposed by Light for an exudative effusion are met if at least one of the following exists (Light's criteria) [2]:
- The ratio of pleural fluid protein to serum protein is greater than 0.5
- The ratio of pleural fluid LDH and serum LDH is greater than 0.6
- Pleural fluid LDH is more than two-thirds normal upper limit for serum
Do we have to know the NEW criteria????
Dr Virgo this is great!! You did a lot of work on this.. Thats what its about - --"Passion" baby..
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| dr.wad
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thaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaank u
DrVirgo.
very nice...we need another job like this
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