Dengue Shock Syndrome with Recurrent Shock and Obesity in Children: A Case Report

Abstract

Introduction: Dengue fever remains a major global health problem that is widespread in tropical and subtropical regions. DSS is one of the dangerous clinical manifestations of dengue infection, characterized by severe plasma leakage due to increased vascular permeability leading to a progressive decrease in intravascular volume. Obesity has been proposed as a potential risk factor for the development of DSS in children. Management with proper fluid resuscitation is essential to prevent worsening in patients with Dengue Shock Syndrom. Case Presentation: This study reports a 5-year-old obese pediatric patient with a body mass index of 31 kg/m2 who developed Dengue Shock Syndrome and recurrent shock. Vital signs examination at the initial examination obtained a pulse rate of 99x / min palpable weak, not strong lift with a temperature of 36oCand extremities acral palpable was cold with Capillary Refill Time (CRT) elongated > 2 seconds. The patient was given initial management in the ER in the form of oxygenation with a 2 lpm nasal cannula, then given lactate ringer (RL) as a fluid teraphy 10cc/kgBB, which was 310cc finished in 30 minutes. Initial complete blood hematological examination showed a leukopenia result of 3.1 x103/uL. The patient had an increased hematocrit of 51% with a haemoglobin level of 17g/dL. Platelet levels were found to be below normal levels at 60 x103/uL. The patient experienced recurrent shock during treatment. The patient was given several rounds of fluid resuscitation but worsened during treatment. The patient had seizures leading to respiratory arrest and cardiac arrest. The patient was later pronounced dead after cardiopulmonary resuscitation was unsuccessful. Conclusion: Dengue infection with obesity has a higher risk of Dengue Shock Syndrome in children. Management with proper fluid resuscitation is important in the hope of reducing morbidity and mortality of Dengue Shock Syndrome in children.