This patient, a morbidly obese 17yearold boy (310 pounds), was admitted complain

Question

This patient, a morbidly obese 17yearold boy (310 pounds), was admitted complaining of chest pains and difficulty breathing. His temperature was 97.3ºF, pulse 109, BP 183/106, respiration 32. Lungs were clear with no rhonchi or rales. Radiology showed an infiltrate in the right lobe, and his admission diagnosis was right lobe pneumonia with empyema and respiratory failure.

Thoracentesis was performed, and right lobe pleural fluid was obtained (tube 1) that showed color yellow; appearance cloudy; supernatant yellow and clear; 22,750 total nucleated cells/mm3; 2750 RBCs/mm3; lymphocytes 1%; neutrophils 94%; monocytes 5%; Tests on the pleural fluid included AFB culture and smear (negative); Gram’s stain for organisms (negative); aerobic C&S negative; culture for fungus negative; total protein 5.4 g/dL (serum was 7.2 g/dL); LDH 1160 U/L (serum was 150 U/L), and glucose 6 mg/dL (serum was 80 mg/dL).

Case Question

1. Based on the above lab results for this pleural fluid, should the fluid be classified as a transudate or exudate?

Explanation / Answer

1. Based on the above lab results for this pleural fluid, the fluid is classified as a exudate.

All of the characters show the features of exudate fluid including appearance cloudy, total protein 5.4 g/dL (serum was 7.2 g/dL); total protein 5.4 g/dL > 2.9 g/dL. Exudate fluid is rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues.

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