Patient developed pleural effusion 9 months ago; Initially attributed to cancer, then lung damage due to radiation administered for cancer. After a couple months of thoracentisis, scopes, biopsy, it was determined it was due to advanced liver failure Talc treatment did not work in sealing the lung due to the nature of the cause. Pleural catheter implanted as fluid build up was significant (1500 ml drained every other day). Subsequently and alternatively, patient developed cellulitis and c.diff. This resulted in severe edema in the legs. Fluid began weeping through skin profusely; skin has started to deteriorate, and patient actually leaves puddles after sitting or laying for as little as 10 minutes. Recently, pleural effusion as diminished, and lung may finally be sealing - however, now acute acites has developed. The fluid build-up has been attempted to be controlled through the use of aldactone and lasix, to little or no avail, as well as restricted fluid intake and salt restricted diet. Sodium, potassium, creatinine, calcium, BUN, and electrolyte levels are all over the place, and naturally, protien in the blood is virtually non-existent. Albumen has been administered as a short term fix in the hospitalfrom time to time to little avail. Consultation set with an alternative compression therapy specialist for the legs, but there is a fear that will increase the fluids in the abdomen and potentially re-instigate pleural effusion.
Doctors are virtually stumped, and other than drainage and controlling with diet, can not provide any help or suggestions to build protien in the blood (we understand you need the liver to do this, which is a non-existent option); not a candidate for transplant due to age, and TIPS is no longer an option due to clots in the liver as well as a bout with encephalopathy.
While I know this all sounds as though it leads to a dead-end, I just thought I would throw this out there to see if anyone has found anything - alternative or otherwise - that has or might help get rid of or restrict further this fluid build up. We are at a total loss.