Timing, predictors, and progress of third space fluid accumulation during preliminary phase fluid resuscitation in adult patients with dengue

Summary Background Fluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommended predictors of DHF for adults with dengue is questionable as these are based on studies conducted in children. Methods One hundred and two adults with dengue were prospe...

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Bibliographic Details
Published in:International journal of infectious diseases 2013-07, Vol.17 (7), p.e505-e509
Main Authors: Premaratna, R, Ragupathy, A, Miththinda, J.K.N.D, de Silva, H.J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antibodies, Viral - blood
Body Fluids - physiology
Dengue
Enzyme-Linked Immunosorbent Assay
Female
Fluid Therapy - methods
Follow-Up Studies
Humans
Infectious Disease
Male
Predictive Value of Tests
Predictors
Prospective Studies
Pulmonary/Respiratory
Resuscitation - methods
Severe Dengue - classification
Severe Dengue - diagnosis
Severe Dengue - therapy
Sri Lanka
Third space fluid accumulation
Time Factors
Young Adult
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Summary:Summary Background Fluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommended predictors of DHF for adults with dengue is questionable as these are based on studies conducted in children. Methods One hundred and two adults with dengue were prospectively followed up to investigate whether home-based or hospital-based early phase fluid resuscitation has an impact on clinical and hematological parameters used for the diagnosis of early or critical phase fluid leakage. Results In the majority of subjects, third space fluid accumulation (TSFA) was detected on the fifth and sixth days of infection. The quantity and quality of fluids administered played no role in TSFA. A reduction in systolic blood pressure appeared to be more helpful than a reduction in pulse pressure in predicting fluid leakage. TSFA occurred with lower percentage rises in packed cell volume (PCV) than stated in the current recommendations. A rapid reduction in platelets, progressive reduction in white blood cells, percentage rises in Haemoglobin (Hb), and PCV, and rises in aspartate aminotransferase and alanine aminotransferase were observed in patients with TSFA and therefore with the development of severe illness. Conclusions Clinicians should be aware of the limitations of currently recommended predictors of DHF in adult patients who are receiving fluid resuscitation.
ISSN:1201-9712
1878-3511
DOI:10.1016/j.ijid.2012.12.021