Ascitic fluid evaluation

ASCITIC FLUID EVALUATION
  • Exfoliative cytologic examination and bacterial culture and antibiotic sensitivity—remove approximately 3–5 mL of abdominal fluid via aseptic technique.

Transudate

  • Clear and colorless
  • Protein < 2.5 g/dL
  • Specific gravity < 1.018
  • Cells < 1000/mm3—neutrophils and mesothelial cells

Modified Transudate

  • Red or pink; may be slightly cloudy
  • Protein 2.5–5.0 g/dL
  • Specific gravity > 1.018
  • Cells < 5000/mm3—neutrophils, mesothelial cells, erythrocytes, and lymphocytes

Exudate (Nonseptic)

  • Pink or white; cloudy
  • Protein 2.5–5.0 g/dL
  • Specific gravity > 1.018
  • Cells 5,000–50,000/mm3—neutrophils, mesothelial cells, macrophages, erythrocytes, and lymphocytes

Exudate (Septic)

  • Red, white, or yellow; cloudy
  • Protein > 4.0 g/dL
  • Specific gravity > 1.018
  • Cells 5,000–100,000/mm3—neutrophils, mesothelial cells, macrophages, erythrocytes, lymphocytes, and bacteria

Hemorrhage

  • Red; spun supernatant clear and sediment red
  • Protein > 5.5 g/dL
  • Specific gravity 1.007–1.027
  • Cells consistent with peripheral blood
  • Does not clot

Chyle

  • Pink, straw, or white
  • Protein 2.5–7.0 g/dL
  • Specific gravity 1.007–> 1.040
  • Cells < 10,000/mm3—neutrophils, mesothelial cells, and large population of small lymphocytes
  • Other—fluid in tube separates into creamlike layer when refrigerated; fat droplets stain with Sudan III.

Pseudochyle

  • White
  • Protein > 2.5 g/dL
  • Specific gravity 1.007–1.040
  • Cells < 10,000/mm3—neutrophils, mesothelial cells, and small lymphocytes
  • Other—fluid in tube does not separate into creamlike layer when refrigerated; does not stain with Sudan III.

Urine

  • Clear to pale yellow
  • Protein > 2.5 g/dL
  • Specific gravity 1.000–> 1.040
  • Cells 5,000–50,000/mm3—neutrophils, erythrocytes, lymphocytes, and macrophages
  • Other—if the urinary bladder ruptured < 12 h before, urinary glucose and protein could be negative; if bladder ruptured > 12 h before, urine becomes a dialysis medium with ultrafiltrate of plasma, and urine contains glucose and protein.

Bile

  • Slightly cloudy and yellow
  • Protein > 2.5 g/dL
  • Specific gravity > 1.018
  • Cells 5,000–750,000/mm3—neutrophils, erythrocytes, macrophages, and lymphocytes
  • Other—bilirubin confirmed by urine dipstick; nonicteric patient may have gallbladder rupture, biliary tree leakage, or rupture in the proximal bowel.

Last modified: Wednesday, 22 February 2012, 5:41 AM