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1 Department of Medicine, The Johns Hopkins University School of Medicine and the Johns Hopkins Hospital, Baltimore, Md.
The pH, PCO2 and bicarbonate levels were measured in 178 pleural effusions grouped according to preset criteria into various diagnostic categories. The pH PCO2 were found to vary widely, the ranges being 6.80 to 7.60 and 26 to 126 mm Hg, respectively. The effusions associated with pneumonia (parapneumonic effusions) showed the most widely varying values of pH. Apparently the pleural fluid pH has predictive value for the course of parapneumonic effusions. Therapy consisting of antibiotics and thoracentesis alone was inadequate to effect resolution of any of the five parapneumonic effusions with a pH of les than 7.20. None of these five effusions was grossly purulent. On the other hand, all 19 parapneumonic effusions with a pH greater than 7.20 resolved with antibiotic therapy, without tube drainage. The mean pH of tuberculous effusions was significantly lower than the mean pH of malignant effusions. When these two possibilities exist, a pH below 7.30 is highly suggestive of tuberculosis, while a pH greater than 7.40 is highly suggestive of malignancy. it is concluded that the measurement of pleural fluid pH is useful in the diagnosis and management of pleural effusions.
Submitted on October 18, 1972
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