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Diagnostic Value of Ascitic Fluid Lactic Dehydrogenase, Protein, and WBC Levels

Diagnostic Value of Ascitic Fluid Lactic Dehydrogenase, Protein, and WBC Levels Abstract Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of > 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of > 0.6, and an ascitic fluid-serum protein ratio of > 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites. The ascitic fluid LDH level did not exceed 400 SU in any patient with uncomplicated chronic liver disease, whereas in patients with malignant, tuberculous, or pancreatic ascites it exceeded 500 SU in 12/19 patients. The finding of two of the three characteristics indicated a nonhepatic cause for the ascites whereas the absence of all three strongly suggested uncomplicated liver disease as the sole cause. The ascitic fluid WBC count was also useful in that values exceeded 500/cu mm in bacterial and tuberculous peritonitis whereas it was low (297 ± 49/cu mm) in chronic liver disease. (Arch Intern Med 138:1103-1105, 1978) References 1. Sherlock S: Diseases of the Liver and Biliary System , ed 5. Oxford, England, Blackwell Scientific Publications, 1975, p 129. 2. Paddock FK: The diagnostic significance of serous fluid in disease . N Engl J Med 223:1010-1015, 1940.Crossref 3. Rovelstad RA, Bartholomew LG, Cain JC, et al: I. The value of examination of ascitic fluid and blood for lipids and for proteins by electrophoresis . Gastroenterology 34:436-450, 1958. 4. Rovelstad RA, Bartholomew LG, Cain JC: Clinical appraisal of the laboratory studies of ascitic fluid and blood as an aid to diagnosis . Gastroenterology 37:339-345, 1959. 5. Tavel M: Ascites: Etiologic considerations with emphasis on the value of several laboratory findings in diagnosis . Am J Med Sci 237:727-742, 1959.Crossref 6. Pillay VK: Diagnostic significance of protein concentration in serous fluids . S Afr Med J 37:379-381, 1963. 7. Sampliner R, Iber F: High protein ascites in patients with uncomplicated hepatic cirrhosis . Am J Med Sci 267:275-279, 1974.Crossref 8. Light R, MacGregor M, Lucksinger P, et al: Pleural effusions: The diagnostic separation of transudates and exudates . Ann Intern Med 77:507-513, 1972.Crossref 9. Ruprecht AL, Kinney TD: Esophageal varices caused by metastasis of carcinoma to the liver . Am J Dig Dis 1:145-154, 1956.Crossref 10. Wroblewski F, Wroblewski R: The clinical significance of lactic dehydrogenase activity of serous effusions . Ann Intern Med 48:813-822, 1958.Crossref 11. DeTorregrosa MV: Results of lactic dehydrogenase determination in benign and malignant effusions . Am J Med Sci 238:552-556, 1959. 12. Kirkeby K, Prydz H: Lactic dehydrogenase activity in pleural and peritoneal effusions . Scand J Clin Lab Invest 11:185-189, 1959.Crossref 13. Fleisher GA, Bartholomew LG, Cain JC, et al: II. The value of determinations of enzymes in the study of ascitic fluid . Gastroenterology 37:325-331, 1959. 14. Kline MM, McCallum RW, Guth DH: The clinical value of ascitic fluid culture and leukocyte count studies in alcoholic cirrhosis . Gastroenterology 70:408-412, 1976. 15. Conn HO: Spontaneous bacterial peritonitis . Gastroenterology 70:455-457, 1976. 16. McGuchin WF, Soule EH, Cain JC, et al: III. The value of glycoprotein determination and cytology in the study of ascitic fluid . Gastroenterology 37:332-338, 1959. 17. Burack WR, Hollister R: Tuberculous peritonitis . Am J Med 28:510-523, 1960.Crossref 18. Donowitz M, Kerstein M, Spiro H: Pancreatic ascites . Medicine 53:183-195, 1974.Crossref 19. Witte CL, Witte MN, Dumont NE, et al: Protein content in lymph and edema fluids in congestive heart failure . Circulation 40:623-630, 1969.Crossref 20. Witte M, Witte C, Dumont A: Physiologic factors involved in the causation of cirrhotic ascites . Gastroenterology 61:742-750, 1971. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Diagnostic Value of Ascitic Fluid Lactic Dehydrogenase, Protein, and WBC Levels

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1978.03630320041014
Publisher site
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Abstract

Abstract Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of > 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of > 0.6, and an ascitic fluid-serum protein ratio of > 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites. The ascitic fluid LDH level did not exceed 400 SU in any patient with uncomplicated chronic liver disease, whereas in patients with malignant, tuberculous, or pancreatic ascites it exceeded 500 SU in 12/19 patients. The finding of two of the three characteristics indicated a nonhepatic cause for the ascites whereas the absence of all three strongly suggested uncomplicated liver disease as the sole cause. The ascitic fluid WBC count was also useful in that values exceeded 500/cu mm in bacterial and tuberculous peritonitis whereas it was low (297 ± 49/cu mm) in chronic liver disease. (Arch Intern Med 138:1103-1105, 1978) References 1. Sherlock S: Diseases of the Liver and Biliary System , ed 5. Oxford, England, Blackwell Scientific Publications, 1975, p 129. 2. Paddock FK: The diagnostic significance of serous fluid in disease . N Engl J Med 223:1010-1015, 1940.Crossref 3. Rovelstad RA, Bartholomew LG, Cain JC, et al: I. The value of examination of ascitic fluid and blood for lipids and for proteins by electrophoresis . Gastroenterology 34:436-450, 1958. 4. Rovelstad RA, Bartholomew LG, Cain JC: Clinical appraisal of the laboratory studies of ascitic fluid and blood as an aid to diagnosis . Gastroenterology 37:339-345, 1959. 5. Tavel M: Ascites: Etiologic considerations with emphasis on the value of several laboratory findings in diagnosis . Am J Med Sci 237:727-742, 1959.Crossref 6. Pillay VK: Diagnostic significance of protein concentration in serous fluids . S Afr Med J 37:379-381, 1963. 7. Sampliner R, Iber F: High protein ascites in patients with uncomplicated hepatic cirrhosis . Am J Med Sci 267:275-279, 1974.Crossref 8. Light R, MacGregor M, Lucksinger P, et al: Pleural effusions: The diagnostic separation of transudates and exudates . Ann Intern Med 77:507-513, 1972.Crossref 9. Ruprecht AL, Kinney TD: Esophageal varices caused by metastasis of carcinoma to the liver . Am J Dig Dis 1:145-154, 1956.Crossref 10. Wroblewski F, Wroblewski R: The clinical significance of lactic dehydrogenase activity of serous effusions . Ann Intern Med 48:813-822, 1958.Crossref 11. DeTorregrosa MV: Results of lactic dehydrogenase determination in benign and malignant effusions . Am J Med Sci 238:552-556, 1959. 12. Kirkeby K, Prydz H: Lactic dehydrogenase activity in pleural and peritoneal effusions . Scand J Clin Lab Invest 11:185-189, 1959.Crossref 13. Fleisher GA, Bartholomew LG, Cain JC, et al: II. The value of determinations of enzymes in the study of ascitic fluid . Gastroenterology 37:325-331, 1959. 14. Kline MM, McCallum RW, Guth DH: The clinical value of ascitic fluid culture and leukocyte count studies in alcoholic cirrhosis . Gastroenterology 70:408-412, 1976. 15. Conn HO: Spontaneous bacterial peritonitis . Gastroenterology 70:455-457, 1976. 16. McGuchin WF, Soule EH, Cain JC, et al: III. The value of glycoprotein determination and cytology in the study of ascitic fluid . Gastroenterology 37:332-338, 1959. 17. Burack WR, Hollister R: Tuberculous peritonitis . Am J Med 28:510-523, 1960.Crossref 18. Donowitz M, Kerstein M, Spiro H: Pancreatic ascites . Medicine 53:183-195, 1974.Crossref 19. Witte CL, Witte MN, Dumont NE, et al: Protein content in lymph and edema fluids in congestive heart failure . Circulation 40:623-630, 1969.Crossref 20. Witte M, Witte C, Dumont A: Physiologic factors involved in the causation of cirrhotic ascites . Gastroenterology 61:742-750, 1971.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1978

References