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Fluid Analysis:- Part 1 – Pleural, Pericardial, and ascites, Difference of Transudate and Exudate

November 15, 2022Fluid analysisLab Tests

Table of Contents

  • Fluid Analysis
      • Definition of Fluids in various cavities of the body:
      • Types of body fluid found are:
      •  Normal findings of serous fluids:
      • Ascitic fluid normal findings:
    • Characteristic features of Transudate:
      • Mechanism of transudate formation:
      • Features of Transudate:
    • Characteristic features of Exudate:
      • Mechanism of exudate formation: 
      • Features of Exudate:
      • Types of exudates are:
      • Questions and answers:

Fluid Analysis

Definition of Fluids in various cavities of the body:

  1. The fluid is secreted by the serous membranes lining the peritoneum, pleural and pericardial cavities.
  2. Literally, serous fluid means resembling serum.
    1. This serous fluid is found in the pleural, peritoneal, and pericardial cavities, which will lubricate the opposing parietal and visceral membrane surfaces.
    2. Inflammation or infection affecting the cavities causes fluid to accumulate.
  3. Serous fluid is the ultrafiltrate of the plasma.
  4. The fluid formation depends upon the following:
    1. Hydrostatic pressure.
    2. Capillaries permeability.
    3. Colloid osmotic pressure.
    4. Lymphatic drainage.

Types of body fluid found are:

  1. The pericardial cavity around the heart contains the fluid, and the aspiration of the pericardial fluid is called pericardiocentesis.
  2. Peritoneal or ascitic fluid is found in the abdomen. This is the effusion and accumulation of serous fluid in the abdominal cavity. Its aspiration is called paracentesis.
  3. Pleural cavity fluid was found in the chest. And aspiration is called thoracentesis.
  4. Gastric fluid is 1000 to 3000 mL/day.
  5. Bile is 300 to 1000 mL/day.
  6. Saliva is 500 to 1500 mL/day.
  7. Pancreatic fluid is 1000 to 1500 mL/day.
  8. Small intestinal fluid is 1000 to 2000 mL/day.
  9. Urine output is 500 to 1500 mL/day.
  10. Insensible loss through skin and lungs is 600 to 1000 mL/day.
Fluids various sites

Fluids various sites

Various body fluids and their quantities:

Fluid site Quantity Produced 
Saliva 500 to 1500 ml/day
Gastric fluid 1000 to 3000 mL/day
Pancreatic fluid 1000 to 1500 mL/day
Small intestinal fluid 1000 to 2000 mL/day
Bile 300 to 1000 mL/day
Urine output 500 to 1500 mL/day
Loss from the skin and lungs 600 to 1000 mL/day
Synovial fluid Minimal amount, Knee Joint <29 mL
Cerebrospinal fluid Total volume = 90 to 200 mL
Ascitic fluid, pericardial, and pleural fluids These are always an abnormal collection

 Normal findings of serous fluids:

Parameters Characteristic features
Appearance
  1. Usually pale yellow
  2. It may be clear
  3. It has low viscosity
  4. Turbidity indicates increased leucocytes
  5. Red or pink is due to blood
pH
  • 6.8 to 7.6
Specific gravity
  • 1.010 to 1.025
Total protein
  • 1000 to 2000 mg/dL
Globulin
  • 30% to 45%
Albumin
  • 50% to 70%
LDH
  • Increased due to necrosis and dead leucocytes

Ascitic fluid normal findings:

Parameters Characteristic features
Gross appearance
  • It is clear, serous, and light yellow
Protein
  • <4.1 g/dL
Glucose
  • 70 to 100 mg/dL
Amylase
  • 138 to 404 units/L
Alkaline phosphatase
  1. Adult male = 90 to 240 units/L
  2. Female <45 years = 76 to 196 units/L
  3. Female >45 years = 87 to 250 units/L
LDH
  • Like serum LDH level
CEA
  • Negative
Presence of cells
  1. RBC = none
  2. WBCs = <300 /cmm
Bacteria
  • Negative
Fungus
  • Negative
Cytology
  • Negative for malignant cells

Characteristic features of Transudate:

Mechanism of transudate formation:

  1. It is the fluid that accumulates as ultrafiltrate and is called Transudate.
  2. The capillary pore can allow the passing of the protein of mol. Weight of 200,000 to 300,000 daltons.
  3. The larger molecular weight proteins are held back and can not cross the basement membranes.
  4. Transudate accumulates because of the increased hydrostatic pressure in the capillaries.
  5. The fluid is low in protein as compared to plasma.
Transudate mechanism

Transudate mechanism

Features of Transudate:

Parameters Values
Specific gravity 1.016
Protein <3 g/dL
White blood cells Negative
Glucose Normal
LDH Normal

Characteristic features of Exudate:

Mechanism of exudate formation: 

  1. Fluid accumulates because of the injury to the membranes due to infection or inflammation.
  2. The damaged membranes allow passing through the larger molecules of proteins.
Exudate mechanism

Exudate mechanism

Features of Exudate:

Parameters Values/Findings
Specific gravity >1.016
Proteins >3 g/dL
White blood cells Increased in number
Glucose It is decreased
LDH It is increased

Types of exudates are:

  1. Serous.
  2. Fibrinous.
  3. Serofibrinous.
  4. Purulent.
  5. Putrid.
  6. Chylous.
  7. Serosanguinopurulent.

Difference between Transudate and Exudate:

Parameter                           Transudate                        Exudate            
Appearance
  1. Pale yellow
  2. No turbidity
  1. Yellow = inflammatory
  2. Red = hemorrhage
  3. Brown = bilirubin
  4. Turbid, viscous,  cloudy
Protein <3 g/dL >3 g/dL
Fluid protein: serum protein ratio <0.5 >0.5
Fluid LD: LD ratio <0.6 >0.6
Specific gravity <1.016 (<1.015) >1.016 (>1.015)
WBC Absent Increased
LDH Normal  <200 IU/L Increased >200 IU/L
Glucose Normal (equal to serum level) <than or equal to serum
Pleural fluid cholesterol <60 mg/dL >60 mg/dL
Pleural fluid: serum cholesterol  ratio <0.3 >0.3
Pleural fluid: bilirubin ratio <0.6 >0.6
Fibrinogen No clot Clots are seen
Spontaneous clotting Negative May see clot formation
Cell count 300 to 1000 /cmm >1000 /cmm
Differential
  1. Mononuclear cells predominate
  2. <25% neutrophils
  • >25% neutrophils
Fluid Analysis: Fluid exudate/transudate

Fluid Analysis: Fluid exudate/transudate

Questions and answers:

Question 1: What is protein level in transudate?
Show answer
Protein in the transudates is <3 g/dL
Question 2: What is the cell count in the exudate?
Show answer
Cell count in the exudate is >1000/cmm.
Possible References Used
Go Back to Fluid analysis

Comments

mulugeta g/ m Reply
November 6, 2021

we have problem in large in our hospital there is no common job aid for analysis body fluid . would have job aids for routine analysis body fluids

Dr. Riaz Reply
November 6, 2021

You can follow labpedia.net.

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