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Octreotide as a Therapeutic Option for Management of Chylothorax

Pharmacy Practice Resident, Department of Pharmacy Services, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Abdulrazaq S Al-Jazairi, PharmD

Coordinator, Academic Programs and Research; Clinical Pharmacist, Cardiology, Department of Pharmacy, King Faisal Specialist Hospital and Research Center

Reprints: Abdulrazaq S Al-Jazairi PharmD, King Faisal Specialist Hospital and Research Center, MBC-11, PO Box 3354, Riyadh 11211, Saudi Arabia, FAX 966-1-442-7608, E-mail ajazairi{at}kfshrc.edu.sa

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 µg/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.

Key Words: chyle, chylothorax, octreotide, somatostatin

Published Online, March 24, 2003. www.theannals.com, DOI 10.1345/aph.1C265

This article has been cited by other articles:

				S. K. Nair, M. Petko, and M. P. Hayward Aetiology and management of chylothorax in adults Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 362 - 369. [Abstract] [Full Text] [PDF]

				E. H. Chan, J. L. Russell, W. G. Williams, G. S. Van Arsdell, J. G. Coles, and B. W. McCrindle Postoperative Chylothorax After Cardiothoracic Surgery in Children Ann. Thorac. Surg., November 1, 2005; 80(5): 1864 - 1870. [Abstract] [Full Text] [PDF]