On day 2 after left neck dissection, the drain produces 1.4 litres of milky fluid in 24 hours, rising after enteral feeding. The patient is becoming hypocalcaemic. What is the best response?
Output and physiological impact drive escalation; a high-output cervical chyle leak requires early senior intervention rather than serial dietary tweaks alone.
A. Remove the drain to encourage spontaneous closure: An uncontrolled high-output collection risks airway compromise, wound breakdown and chyloma.
B. Escalate promptly with nutritional/electrolyte replacement and early operative or interventional leak control: High and rising output with metabolic consequences is unlikely to respond safely to prolonged observation; management includes pressure/drain strategy, fat modification or parenteral nutrition, and definitive control.
C. Continue a normal long-chain-fat diet: This increases lymph flow through the thoracic duct.
D. Give diuretics as the primary treatment: They worsen volume depletion and do not seal the leak.
E. Wait for severe immunosuppression before intervening: Delay compounds nutritional, immune, respiratory and wound morbidity.
If output were 80 mL/day and falling after a low-fat medium-chain triglyceride diet, conservative management would be reasonable.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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