Fluid Analysis:- Part 1 – Pleural, Pericardial, and ascites, Difference of Transudate and Exudate
Fluid Analysis
Definition of Fluids in various cavities of the body:
- The fluid is secreted by the serous membranes lining the peritoneum, pleural and pericardial cavities.
- Literally, serous fluid means resembling serum.
- This serous fluid is found in the pleural, peritoneal, and pericardial cavities, which will lubricate the opposing parietal and visceral membrane surfaces.
- Inflammation or infection affecting the cavities causes fluid to accumulate.
- Serous fluid is the ultrafiltrate of the plasma.
- The fluid formation depends upon the following:
- Hydrostatic pressure.
- Capillaries permeability.
- Colloid osmotic pressure.
- Lymphatic drainage.
Types of body fluid found are:
- The pericardial cavity around the heart contains the fluid, and the aspiration of the pericardial fluid is called pericardiocentesis.
- 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.
- Pleural cavity fluid was found in the chest. And aspiration is called thoracentesis.
- Gastric fluid is 1000 to 3000 mL/day.
- Bile is 300 to 1000 mL/day.
- Saliva is 500 to 1500 mL/day.
- Pancreatic fluid is 1000 to 1500 mL/day.
- Small intestinal fluid is 1000 to 2000 mL/day.
- Urine output is 500 to 1500 mL/day.
- Insensible loss through skin and lungs is 600 to 1000 mL/day.
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 |
|
pH |
|
Specific gravity |
|
Total protein |
|
Globulin |
|
Albumin |
|
LDH |
|
Ascitic fluid normal findings:
Parameters | Characteristic features |
Gross appearance |
|
Protein |
|
Glucose |
|
Amylase |
|
Alkaline phosphatase |
|
LDH |
|
CEA |
|
Presence of cells |
|
Bacteria |
|
Fungus |
|
Cytology |
|
Characteristic features of Transudate:
Mechanism of transudate formation:
- It is the fluid that accumulates as ultrafiltrate and is called Transudate.
- The capillary pore can allow the passing of the protein of mol. Weight of 200,000 to 300,000 daltons.
- The larger molecular weight proteins are held back and can not cross the basement membranes.
- Transudate accumulates because of the increased hydrostatic pressure in the capillaries.
- The fluid is low in protein as compared to plasma.
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:
- Fluid accumulates because of the injury to the membranes due to infection or inflammation.
- The damaged membranes allow passing through the larger molecules of proteins.
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:
- Serous.
- Fibrinous.
- Serofibrinous.
- Purulent.
- Putrid.
- Chylous.
- Serosanguinopurulent.
Difference between Transudate and Exudate:
Parameter | Transudate | Exudate |
Appearance |
|
|
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 |
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Questions and answers:
Question 1: What is protein level in transudate?
Question 2: What is the cell count in the exudate?
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
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