Reabsorption Phase in Dengue Fever
Fluid and electrolyte reabsorption occurs during the recovery phase of dengue fever, typically beginning after the critical phase (days 3-7) has resolved.
Phases of Dengue Fever
Dengue characteristically follows a triphasic course 1:
- Febrile phase: Initial presentation with fever and systemic symptoms 1
- Critical phase: Typically days 3-7 of illness, characterized by plasma leakage, hemoconcentration, and potential progression to shock 2, 3
- Recovery phase: When plasma leakage stops and reabsorption of extravasated fluids begins 2
The Recovery Phase and Fluid Reabsorption
During the recovery phase, previously leaked intravascular fluid that accumulated in the interstitial space and third spaces (pleural effusions, ascites) is reabsorbed back into the vascular compartment 2, 4. This physiologic process has critical clinical implications:
Key Clinical Characteristics
- Fluid reabsorption expands intravascular volume, which can precipitate heart failure and pulmonary edema if not carefully managed 4
- Hematocrit levels fall as the plasma volume expands from reabsorbed fluid 2
- Diuresis increases as the kidneys handle the expanded intravascular volume 2
- Clinical improvement becomes evident with stabilization of vital signs and return to baseline mental status 2
Critical Management During Reabsorption Phase
Avoid overhydration during the recovery phase, as aggressive fluid administration can lead to pulmonary edema when combined with the physiologic reabsorption of leaked fluids 2. The guidelines emphasize:
- Judicious fluid removal may be necessary after initial shock reversal, with evidence showing that aggressive shock management followed by fluid removal decreased pediatric ICU mortality from 16.6% to 6.3% 2
- Discontinue intravenous fluids once the patient demonstrates adequate oral intake and clinical stability 2
- Monitor for signs of fluid overload: hepatomegaly, pulmonary rales, or respiratory distress 2, 3
Special Considerations in Complicated Cases
In patients who developed acute kidney injury during the critical phase with anuria, continuous renal replacement therapy (CRRT) may be required during the recovery phase to remove the reabsorbed fluids and prevent heart failure and pulmonary edema 4. One case report demonstrated successful management using continuous veno-venous hemodialysis for 138 hours to control fluid states during the reabsorption phase 4.
Common Pitfall to Avoid
The most critical error is continuing aggressive fluid resuscitation into the recovery phase 2. Physicians must recognize when plasma leakage has stopped and reabsorption has begun, then promptly reduce or discontinue intravenous fluids to prevent iatrogenic fluid overload 5.