Trends of fluid requirement in dengue fever and dengue haemorrhagic fever: a single centre experience in Sri Lanka

Abstract

BackgroundMeticulous fluid management is the mainstay of treatment in dengue fever that is currently governed by consensus guidelines rather than by strong research evidence. To examine this issue we audited the fluid requirement of a cohort of adult patients with dengue fever (DF) and dengue haemorrhagic fever (DHF) in a tertiary care clinical setting.ResultsThis retrospective cohort study was conducted from July 2012 to January 2013 in Teaching Hospital, Peradeniya, Sri Lanka. Adult patients with confirmed dengue infection managed according to the national and WHO guidelines were included. Their fluid requirement was audited once data collection was over in both DF and DHF groups. Out of 302 patients, 209 (69%) had serological confirmation of dengue infection, comprising 62 (30%) patients gone into critical phase of DHF. Mean age of the DHF group was 30 years (range 12-63 years) and included more males (n = 42, 68%, p < 0.05). Their mean duration of fever on admission and total duration of fever were 4 days and 6 days respectively. DHF group had high incidence of vomiting, abdominal pain and flushing, lowest platelet counts and highest haematocrit values compared to DF group. In DHF group, the mean total daily requirements of fluid from 2nd to 7th day were 2123, 2733, 2846, 2981, 3139 and 3154 milliliters respectively to maintain a safe haematocrit value and the vital parameters. However, in DF group the fluid requirement was lowest on 3rd day (2158 milliliters). DHF group had significantly high fluid requirement on 5th -7th day compared to DF group (p < 0.05).ConclusionsPatients in critical phase of DHF required a higher volume of fluids from the 3rd day of fever and again on 5th to 7th day of fever. Despite being an audit, these finding could be useful in future updates of guidelines and designing research.

A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis

“…Intravenous fluid must be administered cautiously in the elderly to avoid cardiogenic pulmonary edema, however inadequate fluid replacement can worsen organ failure [9]. The physicians faced the dilemma of fluid therapy in such an elderly cohort.…”

“…However, severe dengue can also occur in adults and the elderly [6–8]. The age of DF cases in Taiwan is generally older than that in other countries [9–13]. The predominant age of patients with DF in the Philippines during 2000 to 2009 was 5–14 years [11], and 24 years in Thailand during 2001 to 2011 [13].…”

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

“…These findings are in keeping with previous studies. Tee et al reported that thrombocytopenia<35,000/mm 3 was seen more in DHF/DSS than DF patients (26) in Malaysia and Kularatne et al reported very similar counts in Sri Lanka (27). Fernandez et al also concluded platelet counts of <50,000/mm 3 to be associated with DHF (18).…”

Efektivitas Biaya Terapi Cairan Kristaloid dan Koloid pada Pasien Anak Demam Berdarah di Rumah Sakit PKU Muhammadiyah Bantul

“…Hasil ratarata lama rawat inap pasien kelompok cairan 15 Manajemen terapi demam berdarah tidak memiliki pengobatan khusus, tetapi resusitasi cairan yang cepat dengan pemantauan sering menjadi langkah utama untuk menyelamatkan hidup. 16 Secara teori, cairan yang digunakan untuk mengatasi kehilangan cairan pada ruang intravaskular meliputi normal salin, ringer laktat ataupun koloid. 17 Cairan koloid memiliki berat molekul yang lebih besar bila dibandingkan dengan kristaloid sehingga dapat bertahan lebih lama di ruang intravaskular, dan akibatnya dapat memberikan oksigenasi jaringan lebih baik serta hemodinamik terjaga lebih stabil.…”