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Thomas D. Boyer, MD; Arthur M. Kahn, MD; Telfer B. Reynolds, MD

Arch Intern Med. 1978;138(7):1103-1105.

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)

Author Affiliations
From the Department of Medicine, University of Southern California School of Medicine, the Los Angeles County-University of Southern California Medical Center, and the Liver Service, John Wesley County Hospital, Los Angeles. Dr Boyer is now at the University of California, San Francisco Medical Center.

Footnotes
Accepted for publication Aug 15, 1977.

Reprint requests to Gastroenterology Unit, University of California, San Francisco Medical Center, San Francisco, CA 94143 (Dr Boyer).

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