Clinical Features of Fluid Overload in Dengue Severe Patients given Hydroxy Ethyl Starch and Isotonic Electrolyte Solution at Ospital Ng Makati

Ma. Lucila  M. Perez,; Ginalyn  P. De Vera,; Paul  M. Cobarrubias,

Clinical Features of Fluid Overload in Dengue Severe Patients given Hydroxy Ethyl Starch and Isotonic Electrolyte Solution at Ospital Ng Makati

Ginalyn P. De Vera | Paul M. Cobarrubias | Ma. Lucila M. Perez

Abstract:

Introduction: Management of Dengue severe cases requires judicious supportive treatment with intravenous fluid (IVF) to maintain adequate circulation. Objective: This study aims to determine the clinical features of fluid overload in Dengue Severe patients in a tertiary government hospital. Methods: Chart review of children 1 to <19 years old, diagnosed as dengue severe (WHO criteria 2012), admitted directly at PICU from January 2014 - December 2016 who developed fluid overload was done. Excluded were those who received IVF from other institution, with gastrointestinal losses and/or taking medications that could alter serum electrolytes, and with other co-morbidities. Results: Among 224 dengue severe cases, 55 (24.5%) had fluid overload. Majority of those with fluid overload were females (19.6%), between 6–10-year-old (10.7%), with normal weight for age/BMI (17.4%) and occurred during the critical phase (16.9%). All patients with fluid overload had chest x-ray findings of congestion and pleural effusion. The mean total volume prior the fluid overload given for HES was 884mL ± 118.7 which was lower than IES (1168.4mL ± 83.2). The mean amount of IES given was about the same at 32ml/kg/day while the HES was 28ml/kg/day. The most common electrolyte derangement on admission was hyponatremia (52.7%) and increased AST and ALT levels. Overall mean PICU stay of cases was 6.1 days ± 5.5. For discharged patients, mean PICU stay was 4.3 ± 0.01 while for those who died it was shorter (0.7 days ± 0.1). Overall mortality rate for dengue severe cases with fluid overload was 41.8% as compared to 10% for all dengue severe cases. Conclusion: Fluid overload was high (24.5%) among dengue severe patients admitted at the PICU. Females, children between 6–10-year-old, with normal weight/BMI for age had higher risk for fluid overload. Majority of patients had hyponatremia and elevated liver enzymes. The death rate for dengue severe cases with fluid overload was 4 times higher than that of dengue severe cases. Careful monitoring of these patients is warranted.