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.

References:

Department of Health National Epidemiology Center Public Health Surveillance and Informatics Division.
WHO South-east Asia Regional Office. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Hemorrhagic Fever. Revised and Expanded Edition, 2011.
Dung NM, Day NP, Tam DT et al. Fluid replacement in dengue shock syndrome; a randomized double blind comparison of four intravenous fluid regimens. Clin Infect Disn1999;29;787-94
Gosling P. Salt of the Earth or a Drop in the Ocean? A Pathophysiological Approach to Fluid Resuscitation. J Emerg Med. 2003; 20:306-315.
Mythen MG, Hamilton MA. Hyperchloremic metabolic acidosis: is it clinically relevant? Tranfus Altern Med 2001; 3:15-9
Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putnam D: Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med. 1983;11: 839-50.
Shoemaker WC, Schluter M, Hopkins JA. Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation. Am J Surg 1981; 142: 73-81
Hauser CJ, Shoemaker WC, Turpin I, al e: Oxygen transport responses to colloids and crystalloids in critically ill surgical patients. Surg Gynecol Obstet 1980; 150: 811-16
Hankeln K, Radel C, Beez M, al e: Comparison of hydroxyethyl starch and lactated ringer’s solution on hemodynamics and oxygen transport of critically ill patients in prospective crossover studies. Crit Care Med 1989; 17: 133-35
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL et.al. The global distribution and burden of dengue. Nature;496:504-507.
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012;6:e1760. doi:10. 1371/journal.pntd.0001760.
Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med. 2005;353:877– 89.
Hammond SN, Balmaseda A, Pérez L, Tellez Y, Saborío SI, Mercado JC, Videa E, Rodriguez Y, Pérez MA, Cuadra R, Solano S, Rocha J, Idiaquez W, Gonzalez A, Harris E. Differences in dengue severity in infants, children, and adults in a 3-year hospital-based study in Nicaragua. Am J Trop Med Hyg. Dec 2005 ;73(6):1063-70.
Akshay Reddy A, Prashanth Reddy T, Pranam GM., Usha Pranam, G. A. Manjunath. Serum sodium as a prognostic marker in dengue fever cases admitted to PICU in Navodaya hospital, Raichur, India. ICJP. Jan 2017;4(1):222-225.Available at https://www.ijpediatrics. com/index.php/ijcp/article/view/131/125
Sinitsky L, Walls D, Nadel S, et al. Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study. Pediatr Crit Care Med. 2015;16:2015-209. Clinical Features of Fluid Overload in Dengue Severe Patients given Hydroxy Ethyl Starch and Isotonic Electrolyte Solution at Ospital Ng Makati