Abstract P-195: FEASIBILITY OF “RESTRICTIVE MAINTENANCE FLUID THERAPY STRATEGY (RMFTS)” IN CHILDREN WITH SEVERE DENGUE PRESENTING IN SHOCK – A PROSPECTIVE EXPLORATORY TRIAL

Abstract

Aims & Objectives: Dengue Fever (DF) is an important tropical infection attributing to mortality in children. Fluid therapy remained as cornerstone in management of Severe Dengue (SD). Current CDC protocol guide initial fluid therapy based on presence of Shock and PCV, while de-escalation is done in staggered manner based on PCV reduction We aimed at studying the feasibility of RMFTS - where after 10 ml/kg crystalloid bolus, maintenance fluid will be immediately reduced to 50 % of Holiday Segar calculated volume and further matched to target FO% < 1% (10 ml/Kg/Day). Methods Children (2months-18years age) with ‘Severe Dengue admitted with Shock – GROUP A’ and ‘Dengue with warning signs (DWS) – GROUP B’ were consecutively enrolled and initiated on RMFTS regimen of fluid therapy after parental consent. PCV, Haemoglobin, BP, HR, RR, Lactate, Ferritin, SGOT, SGPT, eCrCl were measured at baseline and after starting fluid therapy. These measurements were compared between both groups. Results Of 36 children enrolled, 20 were SD with shock and 16 were DWS received fluids in view of vomiting and abdominal symptoms. All these children were treated with RMFTS. Despite longer duration of parenteral fluid therapy in Group-A (3.80 Vs 2.38 days p0.02), quantity of fluid given was comparable (26.35 Vs 23.91 ml/day p0.47) in both groups. Baseline PCV and eCrCl were comparable in both groups. Conclusions RMFTS is feasible to be used in resuscitation of children with SD in shock as in those with DWS. The fall or rise in PCV may not directly help in staggered titration of fluid therapy.