Abstract

BackgroundDengue fever prevalence is rising globally and it causes significant morbidity and mortality. Fluid extravasation during the critical phase of dengue haemorrhagic fever (DHF) leads to shock, multi-organ failure and death if not resuscitated appropriately with fluids. The mainstay of management is judicious fluid replacement using a guideline based, calculated fluid quota of maintenance (M) fluid plus 5% deficit (M + 5% deficit) to prevent organ hypoperfusion.MethodsWe conducted an observational follow-up study in Sri Lanka from January–July 2017 to identify the fluid requirements of DHF patients and to identify whether features of fluid overload are present in patients who exceeded the fluid quota. Patients who developed DHF following admission to the place of study, were recruited and the amount of fluid received during the critical phase was documented.ResultsA total of 115 DHF patients with a mean age of 30.3 (SD 12.2) years were recruited to the study. There were 65 (56.5%) males and the mean fluid requirement was 5279.7 ml (SD 735) over the 48 h. Majority of the study participants (n = 80, 69.6%) received fluid in excess of the recommended maintenance + 5% deficit and this group had higher body mass index (22.75 vs 20.76, p0.03) and a lower white cell count at the onset of the critical phase (3.22 × 103 vs 4.78 × 103, p < 0.001). The highest fluid requirement was seen within the first 12 and 24 h of the critical phase in patients requiring fluid M + 5%–7.5% deficit and ≥ M + 7.5% deficit respectively. Patients exceeding M + 5% deficit had narrow pulse pressure and hypotension compared to the rest. DHF grades III and IV were seen exclusively in patients exceeding the fluid quota indicating higher amount of fluid was given for resuscitation. Fluid overload was detected in 14 (12.1%) patients and diuretic therapy was required in 6 (5.2%) patients.ConclusionsThe majority of patients received fluid in excess of the recommended quota and this group represents patients with narrow pulse pressure and hypotension. Although, fluid overload was infrequent in the study population, clinicians should be cautious when administering fluid in excess of M + 7.5% deficit.

Highlights

  • Dengue fever prevalence is rising globally and it causes significant morbidity and mortality

  • Fluid overload was infrequent in the study population, clinicians should be cautious when administering fluid in excess of M + 7.5% deficit

  • A total of 115 dengue haemorrhagic fever (DHF) patients diagnosed according to the World Health Organization (WHO) criteria were enrolled to the study

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Summary

Introduction

Dengue fever prevalence is rising globally and it causes significant morbidity and mortality. Fluid extravasation during the critical phase of dengue haemorrhagic fever (DHF) leads to shock, multi-organ failure and death if not resuscitated appropriately with fluids. Dengue has caused several major outbreaks in Sri Lanka and the largest epidemic was in 2017 with 110,327 reported cases and 301 deaths during the first 7 months [4]. According to the World Health Organization (WHO) guidelines (revised and expanded edition 2011), four criteria are required to meet a case definition of DHF; fever, hemorrhagic tendency, thrombocytopenia (platelet count < 100,000 /mm3), and evidence of plasma leakage as shown by the presence of pleural effusion, ascites, or an increase in packed cell volume (PCV) by 20% [6]. Due to the specificity of these symptoms and signs, diagnosis of DHF does not require laboratory evidence of dengue virus infection [8]

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