Chyloperitoneum PD Milky Effluent Triglycerides — ESENeph MCQ

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ModeratePeritoneal DialysisChyloperitoneum PD Milky Effluent TriglyceridesESENeph

A 44-year-old man on peritoneal dialysis notices that his PD effluent has turned milky-white. There is no abdominal pain, fever, or tenderness. PD effluent WCC is 25/mm3 (normal). Triglyceride level in the effluent is markedly elevated. What is this condition?

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Correct answer: B — Chylous PD effluent (chyloperitoneum)

Milky-white PD effluent with elevated triglyceride content and NORMAL WCC (no peritonitis) is chyloperitoneum — chylous ascites communicating with the PD fluid. Causes include: lymphatic obstruction (malignancy, post-surgical, cirrhosis), pancreatitis, medications (calcium channel blockers rarely), or idiopathic. The triglyceride level in the effluent exceeds plasma levels and lipoprotein electrophoresis shows chylomicrons. It is distinguished from peritonitis by the normal/low WCC. Management: dietary modification (medium-chain triglycerides bypass lymphatic absorption), investigation for underlying cause (CT abdomen for lymphoma/obstruction), and consideration of temporary resting PD if severe. Most idiopathic cases resolve spontaneously.

Reference: Bargman 2000 – Non-Infectious PD Complications; ISPD 2020 – PD Complications