# Pleural Effusion (Evaluation & Referral) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BTS Pleural Disease Guideline 2023 · MSF Essential Drugs 2024 - paracetamol (oral) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Pleural Effusion - disease-level clinical article (pleural-effusion-referral-clinical.txt) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text PLEURAL EFFUSION (EVALUATION & REFERRAL) Sources: BTS Pleural Disease Guideline 2023 · MSF Essential Drugs 2024 - paracetamol (oral) Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), Pleural Effusion - disease-level clinical article (pleural-effusion-referral- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - How much fluid is present correlates poorly with how severe the symptoms are. - Pleuritic pain typically eases once fluid accumulates, whereas persistent pain suggests a malignant cause such as mesothelioma. [chest pain] - Rarely, a large effusion is big enough to cause hemodynamic changes that mimic cardiac tamponade. SIGNS - what you find (3) - Large effusions show intercostal fullness, dullness to percussion, reduced breath sounds and fremitus, with egophony strongest at the upper border. - A pleural friction rub, easily mistaken for coarse crackles, is heard during active pleuritis before fluid accumulates. [crackles · friction rub] - Jugular venous distension, an S3, and pedal edema point to heart failure; ascites with caput medusae points to advanced cirrhosis. [ascites · cirrhosis · leg swelling · raised JVP] TESTS (9) - The meniscus sign on an upright film indicates over 200 mL of fluid with blunting of the costophrenic angle. - A lateral decubitus radiograph can pick up as little as 50 mL of pleural fluid. - Every new effusion warrants thoracentesis to find the cause, except when heart failure is strongly suspected, where a diuretic trial is tried first. - A serum-to-pleural albumin gradient over 1.2 g/dL, or a protein gradient over 2.5 g/dL, points to a transudate in suspected heart failure. - Lymphocyte-predominant fluid points to tuberculosis, a post-CABG state, RA, yellow nail syndrome, malignancy, or chylothorax. - A pleural fluid pH under 7.2 in pneumonia signals a complicated effusion that almost always needs chest-tube drainage. - Pleural fluid triglycerides above 110 mg/dL, with a milky appearance, define a chylothorax. - Hemothorax is confirmed when pleural fluid hematocrit exceeds half the serum hematocrit value. - Cytology sensitivity for malignant effusion is about 60% after one tap, rising to 90% after three samples on separate days. IF NOT THIS - what else fits (6) - Transudative effusions commonly arise from heart failure or pulmonary embolism. - Cirrhosis and peritoneal dialysis are infradiaphragmatic causes of transudative effusion. - Nephrotic syndrome and hypoalbuminemia from malnutrition or organ failure can also cause a transudate. - Tuberculosis remains a major infectious cause of exudative effusion in developing countries. - Mesothelioma is an important cause to weigh, especially with a history of asbestos exposure. - Meigs syndrome combines pleural effusion with ascites in the setting of a pelvic tumor. Source StatPearls "Pleural Effusion" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 500-1000 mg three or four times a day PRN (max 4000 mg/day) for pleuritic chest pain while arranging urgent specialist investigation Peds 10-15 mg/kg/dose [child max 500 mg] (Child under 1 month: 10 mg/kg 3 or 4 times daily (max 40 mg/kg daily); Child 1 month and over: 15 mg/kg 3 or 4 times daily (max 60 mg/kg daily)) 3kg -> 30-45 mg/dose 4kg -> 40-60 mg/dose 5kg -> 50-75 mg/dose 6kg -> 60-90 mg/dose 7kg -> 70-105 mg/dose 8kg -> 80-120 mg/dose 9kg -> 90-135 mg/dose 10kg -> 100-150 mg/dose 11kg -> 110-165 mg/dose 12kg -> 120-180 mg/dose 13kg -> 130-195 mg/dose 14kg -> 140-210 mg/dose 15kg -> 150-225 mg/dose 16kg -> 160-240 mg/dose 17kg -> 170-255 mg/dose 18kg -> 180-270 mg/dose 19kg -> 190-285 mg/dose 20kg -> 200-300 mg/dose 21kg -> 210-315 mg/dose 22kg -> 220-330 mg/dose 23kg -> 230-345 mg/dose 24kg -> 240-360 mg/dose 25kg -> 250-375 mg/dose 26kg -> 260-390 mg/dose 27kg -> 270-405 mg/dose 28kg -> 280-420 mg/dose 29kg -> 290-435 mg/dose 30kg -> 300-450 mg/dose 31kg -> 310-465 mg/dose 32kg -> 320-480 mg/dose 33kg -> 330-495 mg/dose 34kg -> 340-500 mg/dose (upper capped) 35kg -> 350-500 mg/dose (upper capped) 36kg -> 360-500 mg/dose (upper capped) 37kg -> 370-500 mg/dose (upper capped) 38kg -> 380-500 mg/dose (upper capped) 39kg -> 390-500 mg/dose (upper capped) 40kg -> 400-500 mg/dose (upper capped) 41kg -> 410-500 mg/dose (upper capped) 42kg -> 420-500 mg/dose (upper capped) 43kg -> 430-500 mg/dose (upper capped) 44kg -> 440-500 mg/dose (upper capped) 45kg -> 450-500 mg/dose (upper capped) 46kg -> 460-500 mg/dose (upper capped) 47kg -> 470-500 mg/dose (upper capped) 48kg -> 480-500 mg/dose (upper capped) 49kg -> 490-500 mg/dose (upper capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Paracetamol is a simple analgesic used to control pleuritic chest pain while the underlying cause of the effusion, infection, malignancy, or heart failure, is urgently investigated; it treats the symptom only. Caution Urgent pulmonology referral is required for ultrasound-guided diagnostic thoracentesis. Do not exceed maximum daily dose (risk of hepatotoxicity). Investigate for underlying infection (empyema), malignancy, or heart failure. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Pleural Effusion - disease-level clinical article (pleural-effusion-referral- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Complex parapneumonic effusion or empyema (pH < 7.2) requires urgent chest tube drainage and antibiotics. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)