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Background
Chylothorax is an uncommon medical complication, characterized by accumulation of chyle. Chyle is the by-product of lipid digestion which leak into thoracic or pleural cavity. The complications from chylothorax can cause severe deterioration in nutritional status, hence are detrimental to patients.
Client History
Mrs. R, a 69 year old female with underlying Type 2 Diabetes Mellitus and hypertension was presented with left chylothorax secondary to Diffuse Large B-Cell Lymphoma (DLBCL). Upon admission, chest tube was inserted to drain out the chyle leak from the pleural cavity and post admission Day 3, chemotherapy was initiated for treatment of B-cell lymphoma.
Assessment
At 155cm and 40kg, she was presented with a BMI of 16.6kg/m2 with severe muscle and fat loss (SGA: Grade C). She also claimed to have loss of appetite and a reported weight loss of approximately 15kgs in the past 6 months (27%). Dietary assessment revealed patient’s estimated daily energy intake was 975kcal and protein of 39g.
Nutrition Diagnosis
Inadequate protein energy intake related to physiological causes increasing nutrient needs (chylothorax with underlying DLBCL undergoing chemotherapy) as evidenced by energy intake of 975kcal/day (61%) and protein intake of 39g/day (54%).
Dietary Prescription and Intervention
Due to her poor oral intake, patient was referred for low salt, low fat diet with oral nutrition supplement (achieving ~1413 kcal/day, 68g protein/day, and 43g fat/day). However, with increased chyle flow, increased protein pleural fluid and deteriorating physiological status, she was switched to a diabetic, high protein and low fat diet, supplemented with a low fat, MCT based oral nutrition supplement (achieving ~915 kcal/day & 36.5 g protein/day, 13 g fat/day).
Outcome and follow-up
Monitoring parameters included dietary intake (energy, protein and fat), biochemical data (albumin, total protein and electrolytes), and weight. Significant improvement was observed in Mrs. R’s oral diet, however, due to her complicated medical conditions, patient passed away.