Chylothorax drainage is often milky white. What management may be required?

• A. No dietary changes are needed.
• B. Low-sodium diet only.
• C. High-fat diet.
• D. Dietary modifications.

Answer: (D)

Chylothorax drainage is milky because the thoracic duct leak releases triglyceride-rich lymph (chyle) into the pleural space. To promote healing, the amount of chyle flowing through the lymphatics needs to be reduced. Dietary modifications are often required, such as a fat-restricted diet or a medium-chain triglyceride (MCT) diet, because long-chain fats are absorbed via the lymphatics and feed chyle, while MCTs are absorbed directly into the portal circulation and don’t significantly increase chyle flow. In some cases, total parenteral nutrition may be used if chyle output remains high. Therefore, dietary modifications are the appropriate management. A and B don’t target chyle production, and C would worsen it.