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Octreotide as a therapeutic option for management of chylothorax
Sulaiman A Al-Zubairy1, Abdulrazaq S Al-Jazairi
1Department of Pharmacy Services, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
Octreotide effectively managed post-cardiac surgery chylothorax in an infant. This treatment reduced chyle drainage, showing promise for similar cases.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Gastroenterology
Background:
- Chylothorax, a rare complication post-cardiac surgery, presents a significant management challenge.
- Early diagnosis and intervention are crucial for favorable outcomes in pediatric patients.
Observation:
- A 5-month-old infant with Down syndrome developed chylothorax post-atrioventricular canal repair.
- Continuous pleural fluid drainage indicated significant chyle loss, necessitating therapeutic intervention.
Findings:
- Octreotide administration significantly decreased daily chyle drainage from 7.14 mL/h to 0.83 mL/h within four days.
- Laboratory analysis confirmed chylous fluid, ruling out infection.
Implications:
- Octreotide demonstrates efficacy in managing post-surgical chylothorax by reducing chyle production.
- Further research is warranted to establish octreotide as a standard treatment for pediatric chylothorax.
Objective:
To report a case of post-cardiac surgery-induced chylothorax treated with octreotide and review the literature on octreotide efficacy.
Case Summary:
A 5-month-old boy with Down syndrome was admitted for atrioventricular canal repair. On admission, he was taking captopril and furosemide. On postoperative day 4, he exhibited signs of chest wheezing and crackles, but was without cough or fever. Chest X-ray revealed a moderate right-sided pleural effusion. Accordingly, a pleural catheter was inserted and drained an average of 7.14 mL/h of chylous fluid that day. Laboratory analysis of the pleural fluid revealed a triglyceride level of 89 mg/dL, without bacterial growth. Based on those findings, the diagnosis was chylothorax. Because of the continuous extensive tube drainage, octreotide 3.5 micro g/kg/h was begun. The average daily chyle drainage was reduced from 7.14 one day before octreotide initiation to 0.83 mL/h on day 4 of octreotide therapy. After 4 days of therapy (postoperative day 8), octreotide was discontinued because of the satisfactory response and the pleural catheter was removed.
Discussion:
In our case and the other few cases reported, octreotide showed acceptable efficacy in the management of chylothorax. The mechanism by which octreotide decreases chyle production includes reducing the intestinal absorption of fats, mainly triglycerides, and increasing fecal fat excretion.
Conclusions:
Octreotide may have reduced chyle production in our patient. Further reports and studies assessing octreotide efficacy in the management of chylothorax are warranted.