Milky ascitic fluid in a patient with chylous ascites is most likely to show which laboratory finding?

• A. Elevated triglycerides in ascitic fluid
• B. Elevated amylase in ascitic fluid
• C. Elevated bilirubin in ascitic fluid
• D. High neutrophil count in ascitic fluid

Answer: (B)

Milky ascitic fluid signals chylous ascites, which occurs when lymphatic fluid rich in dietary fat leaks into the peritoneal cavity from lymphatic disruption or obstruction. The hallmark lab finding is markedly elevated triglycerides in the ascitic fluid, typically exceeding about 200 mg/dL, and often with the presence of chylomicrons. This distinguishes it from pancreatic ascites, where amylase is the characteristic elevation due to pancreatic juice leakage. Elevated bilirubin would point toward biliary or hepatic sources, and a high neutrophil count suggests infection rather than chyle leakage. So, the expected lab finding is elevated triglycerides in the ascitic fluid.