A 66-Year-Old Man with Intrapleural Leakage of Parenteral Nutrition Fluid Due to a Malpositioned Central Venous Catheter

BACKGROUND Total parenteral nutrition (TPN) can be indicated when oral and enteral intake are not feasible. TPN requires central venous access. This case describes a 66-year-old man with intrapleural leakage of TPN, due to a malpositioned central venous catheter. CASE REPORT A 66-year-old man was admitted to the Intensive Care Unit (ICU) with septic shock due to cholangitis. On admission to the ICU, a central venous catheter (CVC) was placed in the left internal jugular vein. On day 4, TPN was started because of gastrointestinal intolerance to enteral feeding. On day 5, he developed a bilateral pleural effusion. A pig tail catheter was placed in the left pleural space, draining 2.5 L of a white, milky fluid. Analysis of the fluid showed a transudate according to Light's criteria, high triglyceride levels of 789 mg/dL, but also notably elevated glucose levels of 772 mg/dL, whereby TPN leakage in the pleural cavity was suspected. Radiography while injecting intravenous contrast in the CVC showed contrast extravasation in the upper mediastinum. CONCLUSIONS This report highlights an uncommon complication of TPN and aims to raise awareness of the possibility of TPN fluid leak into the pleural space from a malpositioned CVC. In a patient who develops pleural effusion while receiving TPN, analysis of pleural fluid triglyceride, glucose, and potassium levels can aid in establishing the diagnosis.