Dawaa Reference

chronic

Pleural Effusion (Evaluation & Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

BTS Pleural Disease Guideline 2023 · MSF Essential Drugs 2024 - paracetamol (oral)

Verified against2 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • Pleural Effusion - disease-level clinical article (pleural-effusion-referral-clinical.txt)

Verified date2026-08

Presentation reference

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.

SourceStatPearls "Pleural Effusion" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500-1000 mg three or four times a day PRN (max 4000 mg/day) for pleuritic chest pain while arranging urgent specialist investigation

Paediatric dose

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))

Dose by weight
3kg30-45 mg/dose
4kg40-60 mg/dose
5kg50-75 mg/dose
6kg60-90 mg/dose
7kg70-105 mg/dose
8kg80-120 mg/dose
9kg90-135 mg/dose
10kg100-150 mg/dose
11kg110-165 mg/dose
12kg120-180 mg/dose
13kg130-195 mg/dose
14kg140-210 mg/dose
15kg150-225 mg/dose
16kg160-240 mg/dose
17kg170-255 mg/dose
18kg180-270 mg/dose
19kg190-285 mg/dose
20kg200-300 mg/dose
21kg210-315 mg/dose
22kg220-330 mg/dose
23kg230-345 mg/dose
24kg240-360 mg/dose
25kg250-375 mg/dose
26kg260-390 mg/dose
27kg270-405 mg/dose
28kg280-420 mg/dose
29kg290-435 mg/dose
30kg300-450 mg/dose
31kg310-465 mg/dose
32kg320-480 mg/dose
33kg330-495 mg/dose
34kg340-500 mg/dose (upper capped)
35kg350-500 mg/dose (upper capped)
36kg360-500 mg/dose (upper capped)
37kg370-500 mg/dose (upper capped)
38kg380-500 mg/dose (upper capped)
39kg390-500 mg/dose (upper capped)
40kg400-500 mg/dose (upper capped)
41kg410-500 mg/dose (upper capped)
42kg420-500 mg/dose (upper capped)
43kg430-500 mg/dose (upper capped)
44kg440-500 mg/dose (upper capped)
45kg450-500 mg/dose (upper capped)
46kg460-500 mg/dose (upper capped)
47kg470-500 mg/dose (upper capped)
48kg480-500 mg/dose (upper capped)
49kg490-500 mg/dose (upper capped)
50kg500 mg/dose (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • 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.