From the Guidelines
Fluid management in dengue should prioritize the use of crystalloids, such as normal saline or Ringer's lactate, for initial resuscitation, with a recommended dose of 5-10 ml/kg/hour for 1-2 hours, then reduced to 3-5 ml/kg/hour for 2-4 hours, and further to 2-3 ml/kg/hour based on clinical response, as this approach is supported by the most recent and highest quality study 1. The goal of fluid management in dengue is to maintain adequate circulation during the critical phase of plasma leakage, while avoiding overhydration that can lead to pulmonary edema.
- For patients with mild to moderate dengue without warning signs, oral rehydration with water, juices, or oral rehydration solution is recommended, aiming for 2-3 liters daily for adults.
- Patients should be encouraged to drink frequently in small amounts even if not thirsty.
- For severe dengue or cases with warning signs, intravenous fluid therapy becomes essential, with the choice of fluid being either isotonic crystalloids or colloids, as both can be effective for resuscitation 1.
- Vital signs, urine output, hematocrit levels, and warning signs should be monitored every 1-2 hours during the critical phase.
- If there's significant bleeding or a rising hematocrit despite fluid therapy, blood transfusion may be necessary. The physiological basis for this approach is that dengue causes temporary increased vascular permeability leading to plasma leakage, hypovolemia, and potential shock, requiring careful fluid replacement to maintain circulation while avoiding fluid overload as capillary integrity recovers. In resource-limited settings, the use of crystalloids is preferred due to the high costs and potential side effects of colloids, as noted in a previous study 1. However, the most recent guideline recommends the use of either crystalloids or colloids for resuscitation, with the choice of fluid depending on the individual patient's needs and the availability of resources 1.
From the Research
Fluid Management in Dengue
- Fluid management is a critical aspect of treating dengue, particularly in cases of dengue shock syndrome (DSS) 2, 3, 4, 5, 6
- The goal of fluid management is to restore plasma volume, prevent shock, and support the patient's cardiovascular system 2, 4
Types of Fluids Used
- Crystalloid solutions, such as normal 0.9% saline or Ringer's lactate, are commonly used for fluid resuscitation in dengue patients 2, 5
- Colloid solutions, such as dextran 70 or hydroxyethyl starch, may be used in severe cases of DSS, but their use is associated with a higher risk of adverse events 2, 4, 5
Fluid Requirements
- The fluid requirement for dengue patients varies depending on the severity of the disease and the patient's individual needs 6
- A study found that the mean fluid requirement for adult dengue hemorrhagic fever patients during the critical phase of the illness was 5279.7 ml over 48 hours 6
- The majority of patients received fluid in excess of the recommended maintenance + 5% deficit, which was associated with narrow pulse pressure and hypotension 6
Guidelines for Fluid Management
- Current guidelines recommend initial crystalloid therapy, with consideration of colloids for severe or recalcitrant shock in patients with dengue 3
- The choice of fluid and the volume of fluid administered should be tailored to the individual patient's needs and the phase of the disease 3, 6
- Clinicians should be cautious when administering fluid in excess of the recommended quota to avoid fluid overload 6