Someone recently asked about chylothorax. Interesting,  we just had
one on our wards last week so I was reminded.

        Chylothorax is a result of an interruption or damage to the
thoracic lymphathics.  In the intestine,  large( > C16) fatty acids are
synthesized into triglycerides,  then dumped into the intestinal
lymphatics.  The lymph system then transports these triglyceride droplets
up through the thorax and subsequently dumps them into the cardiovascular
system at the level of the heart.  If due to surgery,  or trauma of some
sort,  this lymph system is disrupted,  the thoracic cavity is filled with
large quantities of triglyceride droplets, that actually look like milk.
This must be constantly drained or the lungs collapse. According to
Nelson's Textbook of Pediatrics,  at least 50% resolve before the age of
one.   Its generally agreed that at least 3-9 months is generally required.
During this time, the infant must be fed high calorie(2X normal), high
protein diets, rich in medium chain triglycerides.  MCT is not dumped into
the lymphatics, but instead is secreted by the gut directly into the blood
stream.

        Also,  these infants should be supplemented with twice the daily
average of oil soluble vitamins,  Vit A, D, E, K.


Tom Hale