darkhorse
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thoracentesis is performed, with the following results:
Appearance: Viscous, cloudy
pH: 7.11
Protein: 5.8 g/dL
LDH: 285 IU/L
Glucose: 66 mg/dL
WBC: 3800/mm3
RBC: 24,000/mm3
PMNs: 93%
Gram stain: Many PMNs; no organism seen
Bacterial cultures are sent, but the results are not currently available. Which characteristic of the pleural
fluid is most suggestive that the patient will require tube thoracostomy?
A. Presence of more than 90% polymorphonucleocytes (PMNs)
B. Glucose less than 100 mg/dL
C. Presence of more than 1000 white blood cells
D. pH less than 7.20
E. Lactate dehydrogenase (LDH) more than two-thirds of the normal upper limit for serum
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| sprint123
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pH less than 7.2
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| me007
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good q. 
The following findings are suggestive of an empyema or parapneumonic effusion that will need a chest tube for complete resolution:
1. Grossly purulent pleural fluid
2. pH level less than 7.2
3. WBC count greater than 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL)
4. Glucose level less than 60 mg/dL
5. Lactate dehydrogenase level greater than 1,000 IU/mL
6. Positive pleural fluid culture
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| drdg
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Good question and good answer too. Thanks
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| darkhorse
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very nice me007!
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| darkhorse
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Thoracentesis is indicated for any patient presenting with pneumonia and a pleural effusion more than 10
mm thick on lateral decubitus imaging because a significant percentage of these patients will show
evidence of bacterial invasion and require further intervention. Other indications for thoracentesis for
pleural effusions that complicate pneumonias include loculation of the pleural fluid and evidence of
thickened parietal pleura on chest CT. The pleural fluid should be sent for cell count, differential, pH,
protein, LDH, glucose, and culture with Gram stain. This will allow one to differentiate a simple
parapneumonic effusion from a complicated one or from empyema. All effusions complicating pneumonia
should be exudative, meeting at least one of Light's criteria: (1) pleural fluid protein/serum protein over
0.5, (2) pleural fluid LDH/serum LDH over 0.6, and (3) pleural fluid LDH more than two-thirds of the
normal upper limit for serum. Factors that increase the likelihood that tube thoracostomy will have to be
performed include loculated pleural fluid, pH below 7.20, pleural fluid glucose below 60 mg/dL, positive
Gram stain or culture of pleural fluid, and presence of gross pus on aspiration.
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| tamerbashir
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| darkhorse
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