P0658 / #2080: COMPARISON OF CUMULATIVE FLUID INTAKE, FLUID BALANCE, AND BLOOD LACTATE LEVEL AFTER FLUID RESUSCITATION IN PEDIATRIC DENGUE SHOCK USING RINGER LACTATE AND HYPERTONIC LACTATE SOLUTION

Abstract

Aims & Objectives: To compare the effect of Ringer Lactate (RL) vs hypertonic sodium lactate (HSL) on fluid accumulation, fluid balance, blood lactate and lactate clearance as reflection of restoration of tissue perfusion. Methods: A retrospective study based on year 2010 data of children age 2-14 yrs suffered from DSS newly treated in Department of Child Health, Hasan Sadikin Hospital, Bandung, Indonesia. Early fluid resuscitation applied with either HSL for 12 hours (5 mL/kgBW in 15 minutes, followed by 1 mL/kg/h for 12 hours, then changed by RL 1 mL/kgBW/hr for 12 hours) or RL (20 mL/kgBW in 15 minutes, then followed by decreasing dose of 10, 7, 5, and 3 mL/kgBW/hr every 3 hour within 12 hours). We searching for shock recovery, serial fluid-in and urine output, and blood lactate. Of 50 patients, 46 (24 and 22 patients in HSL and RL groups respectively) are analyzed. Results: Hemodynamic recovery faster in HSL group, fluid accumulation was two third higher in RL group. Near zero fluid balance were achieved within 12 hours by HSL group. We found obvious palpebral edema in all RL group and slightly in HSL group. Moreover, HSL might avoid reperfusion injury and restore tissue perfusion reflected by highly significant decrease in lactate clearance. Blood lactate decreased highly significant in both groups (p<0.001), whereas in RL group, blood lactate tend to rebound at hour 12 and 24 (p=0.811). Conclusions: Small volume resuscitation with HSL tends recover faster in DSS, avoid fluid accumulation, restore tissue perfusion and avoid reperfusion injury.