SHM Converge Scientific Abstract ePoster Gallery-Severe Hyponatremia Secondary to the Copious Drainage of Chylous Ascites

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This case describes a 49-year-old man with a history of alcohol misuse who underwent elective umbilical hernia repair. During surgery, surgeons unexpectedly encountered a large amount of chylous ascites, and about one liter of fluid was initially drained. Laparoscopy showed a cirrhotic-appearing liver and abundant chylous ascites, confirming chylous fluid with a triglyceride level of 915 mg/dL. Because of concern for wound dehiscence, a Jackson-Pratt drain was placed.<br /><br />Ten days later, the patient was hospitalized with nausea, headache, dizziness, poor oral intake, and very high drain output—up to 5 liters per day. He was found to have severe hyponatremia, with serum sodium dropping from 137 mmol/L preoperatively to 113 mmol/L. Urine and serum studies suggested volume depletion, and imaging again showed cirrhotic liver morphology with ascites. Infectious causes such as tuberculosis and parasites were excluded.<br /><br />The patient’s hyponatremia was attributed to massive ongoing loss of sodium-rich chylous ascitic fluid through the drain, combined with inadequate oral solute replacement. He was treated with cautious normal saline and removal of the drain, after which his sodium corrected to 137 mmol/L. He was discharged on diuretics and antibiotic prophylaxis with outpatient hepatology follow-up.<br /><br />The report highlights that chylous ascites is rare, especially in cirrhosis, but can lead to significant sodium loss because its sodium content approximates plasma levels. The key lesson is that high-output abdominal drains can cause severe hyponatremia if fluid losses are not carefully monitored and replaced.

Asset Subtitle

Nicole E. Green

Meta Tag

Author List Charles J. Van Hook, Jessica M. Altree, Kevin R. Berg, Nicole E. Green

Category Clinical Vignettes

Concept Chylous Ascites

Concept Hyponatremia

Concept Ascitic Triglycerides

Concept Volume Depletion

Concept Cirrhosis

Distinguished Non-Finalist

Presenter Organization University of Pikeville

Presenting Author Nicole E. Green

Track Adult

Keywords

chylous ascites

hyponatremia

cirrhosis

umbilical hernia repair

Jackson-Pratt drain

sodium loss

alcohol misuse

abdominal surgery

volume depletion

ascitic fluid

Chylous Ascites

Hyponatremia

Ascitic Triglycerides

Volume Depletion

Cirrhosis