From the Guidelines
The triglyceride serum to fluid ratio is a valuable diagnostic tool for identifying chylous effusions, with a ratio greater than 1.0 strongly suggesting a chylous nature of the fluid, as supported by the most recent and highest quality study available 1. To perform this test, samples of both the patient's serum and the effusion fluid should be collected simultaneously and analyzed for triglyceride levels.
- A ratio exceeding 1.0, especially when combined with an absolute triglyceride level in the fluid greater than 110 mg/dL, provides strong evidence of a chylous effusion.
- This finding indicates leakage of lymphatic fluid containing chylomicrons into a body cavity, which may result from trauma, malignancy, inflammation, or congenital abnormalities affecting the lymphatic system.
- The ratio is particularly useful in cases where visual inspection of the fluid is ambiguous, as not all milky-appearing effusions are chylous, and not all chylous effusions appear milky. The Endocrine Society recently published evidence-based recommendations on the diagnosis and management of hypertriglyceridemia in adults, which may be relevant in the context of interpreting triglyceride levels in serum and fluid samples 1. However, the most recent and highest quality study available 1 provides the best guidance on the use of triglyceride serum to fluid ratio in clinical practice.
- In this study, the authors recommend monitoring serum triglyceride levels regularly in patients receiving intravenous lipid emulsions, and reducing the dosage of lipids if serum triglyceride concentrations exceed 3 mmol/L (265 mg/dL) in infants or 4.5 mmol/L (400 mg/dL) in older children.
- The study also highlights the importance of interpreting serum triglyceride levels in the context of the patient's clinical condition, including the presence of secondary causes of hyperlipidemia and the risk of hypertriglyceridemia.
From the Research
Triglyceride Serum to Fluid Ratio
- The triglyceride serum to fluid ratio is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the importance of triglyceride levels in the diagnosis and treatment of hypertriglyceridemia, as well as their association with cardiovascular disease and pancreatitis 2, 3, 4, 5, 6.
- The studies provide information on the management of hypertriglyceridemia, including lifestyle modifications, dietary changes, and medication therapy 2, 3, 4, 5, 6.
- Specifically, the studies mention that elevated triglyceride levels can be lowered through lifestyle modifications such as weight loss, reduced intake of rapidly metabolized carbohydrates, and increased physical activity 2, 3, 5.
- Additionally, medications such as fibrates, omega-3 fatty acids, and statins can be used to lower triglyceride levels, although their efficacy and safety vary 3, 4, 5, 6.
- The studies also highlight the importance of calculating a patient's 10-year risk of atherosclerotic cardiovascular disease to determine the role of medications in managing hypertriglyceridemia 3.