Fluid requirement in adult dengue haemorrhagic fever patients during the critical phase of the illness: an observational study

Abstract

Background 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. 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. Methods We 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. Results A 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. Conclusions The 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.

Warning Signs in Predicting Severe Pediatric Dengue Infection

“…Severe plasma leakage often manifests as pleural effusion, ascites, hypoproteinemia, or hemoconcentration, causing NSD to progress to SD because of hypovolemic shock. [25][26][27] Our study observed that fluid accumulation was significantly associated with SD infection. If left untreated, patients with fluid accumulation will develop hypotension, followed by a rapid decline in systolic blood pressure, and irreversible shock and death may ensue despite resuscitation attempts.…”

An Overview of the Theory of Planned Behavior Approach in Nursing Care for Dengue Fever Patients

“…Dengue fever is a disease that requires strict observation, especially in observing fluid needs, so it requires a record or complete documentation of actions [21], [22]. The nurses realize that documenting nursing care is a form of nurse's responsibility in writing what nurses do during the treatment of dengue patients.…”

Fluid Management in Dengue Critical Phase: Which, When, How Much?

“…The critical phase starts around the time of Since there is no specific antiviral treatment that modifies the natural history of the disease [7], the meticulous IVF administration has become the most effective strategy [6]. The recommendations of the different societies on IVF management in adult population with dengue are mainly extrapolated from studies performed on pediatric population [9][10][11], or based on consensus of expert opinions, assumptions from observational studies with poor methodological rigor.…”

“…Dengue has a cyclic epidemic behavior, with approximately half of the global population in risk of infection [1][2][3]. At least 390 million infections are reported each year, causing high morbidity and mortality among young adults, with an important cost for society through the loss of productivity of the affected population [3][4][5][6]. Delays on fluid therapy during critical phase has been identified as the leading cause of death [1,7].…”

“…Once the plasma leakage ceases, the extravasated fluids are reabsorbed into the intravascular space in most of the patients [2]. In other cases, there are complications; some of which are related with fluid overload beyond the tissue damage caused by the viral infection [6].…”