Fluid requirement in adult dengue haemorrhagic fever patients during the critical phase of the illness: an observational study

Abstract

Background: Dengue fever prevalence is rising globally and it causes significant morbidity and mortality. Fluid extravasation during the critical phase of dengue haemorrhagic fever (DHF) leads to shock, multi-organ failure and death if not resuscitated appropriately with fluids. The mainstay of management is judicious fluid replacement using a guideline based, calculated fluid quota of maintenance (M) fluid plus 5% deficit (M + 5% deficit) to prevent organ hypoperfusion.

Methods: We conducted an observational follow-up study in Sri Lanka from January-July 2017 to identify the fluid requirements of DHF patients and to identify whether features of fluid overload are present in patients who exceeded the fluid quota. Patients who developed DHF following admission to the place of study, were recruited and the amount of fluid received during the critical phase was documented.

Results: A total of 115 DHF patients with a mean age of 30.3 (SD 12.2) years were recruited to the study. There were 65 (56.5%) males and the mean fluid requirement was 5279.7 ml (SD 735) over the 48 h. Majority of the study participants (n = 80, 69.6%) received fluid in excess of the recommended maintenance + 5% deficit and this group had higher body mass index (22.75 vs 20.76, p0.03) and a lower white cell count at the onset of the critical phase (3.22 × 103 vs 4.78 × 103, p < 0.001). The highest fluid requirement was seen within the first 12 and 24 h of the critical phase in patients requiring fluid M + 5%-7.5% deficit and ≥ M + 7.5% deficit respectively. Patients exceeding M + 5% deficit had narrow pulse pressure and hypotension compared to the rest. DHF grades III and IV were seen exclusively in patients exceeding the fluid quota indicating higher amount of fluid was given for resuscitation. Fluid overload was detected in 14 (12.1%) patients and diuretic therapy was required in 6 (5.2%) patients.

Conclusions: The majority of patients received fluid in excess of the recommended quota and this group represents patients with narrow pulse pressure and hypotension. Although, fluid overload was infrequent in the study population, clinicians should be cautious when administering fluid in excess of M + 7.5% deficit.

Keywords: Critical phase; Dengue fever; Dengue haemorrhagic fever; Fluid leakage; Fluid overload; Fluid requirement.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Fluid requirement over the course of 48 h of the critical phase. Figure shows the fluid requirement in the patients who received fluid (a) equal or less than M + 5% deficit, (b) M+ 5–7.5% deficit and (c) more than M + 7.5% deficit. Fluid requirement at 0–12 h was compared to each time point in the 3 graphs and analysed by 1-way ANOVA, *p < 0.05, ***p < 0.001, *****p < 0.0001, ns-not significant

Fig. 2

Fluid requirement of the study population based on the body weight. Fluid requirement of the patients were plotted against the body weight of the patients and analysed to identify the correlation between the variables. r- Spearman r