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Fluid management
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Haemodynamic assessment
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Fluid therapy
In dengue without warning signs
In dengue with warning signs or severe dengue
without shock
In dengue with compensated shock
In dengue with hypotensive or decompensated
shock
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Fluid therapy in dengue without
warning signs
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Fluid therapy in dengue without
warning signs
Encourage oral fluids
If does not tolerate, iv fluids at maintenance
rate
Maintenance fluids
4 mL/kg/h for first 10 kg BW
+ 2 mL/kg/h for next 10 kg BW+ 1 mL/kg/h for subsequent kg BW
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Fluid therapy in dengue with warning
signs or severe dengue without shock
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Fluid therapy in dengue with warning
signs or severe dengue without shock
In critical phase:
Start iv fluids 57 ml/ kg/hr X 12 hours
then reduce to 35 ml/kg/hr X 24 hours
then reduce to 23 ml/kg/hr or less according
to the clinical response
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Fluid therapy in compensated shock
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Fluid therapy in severe dengue with
shock
Shock is the result of inadequately treated plasmaleakage bleeding
Prolonged shock leads to metabolic acidosis and
multi-organ dysfunction
Early and prompt fluid therapy lead to betteroutcome
Should be nursed in High dependency unit or ICU
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Fluid therapy in severe dengue with
shock
Following initial resuscitation there maybe recurrent
episodes of shock because plasma leakage can
continue for 24-48 hours
no clear advantage of using colloids over crystalloids
in terms of the overall outcome.
colloid may be preferable in patients with intractableshock in the initial resuscitation.
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Reabsorption phase
Usually 48 hours from onset of critical phase,
sometimes sooner
By this time, significant cumulative positive fluid
balance Reabsorption of fluids from third space into
circulation causing haemodilution, diuresis,
hypertension
Further IV fluids will lead to acute pulmonary
oedema
May give small doses of frusemide
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Fluid therapy in decompensated/
hypotensive shock
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After 1st fluid bolus
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After 1st fluid bolus
After 2nd fluid bolus
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After 2nd fluid bolus
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Fluid therapy general rules
Understand the natural history of the disease
Decide which case classification and phase of
the disease the patient is in
Judicious fluid management and regular
monitoring is the key to successful
management of dengue with warning signs orsevere dengue.
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Fluid therapy - general rules
Frequent adjustment of maintenance fluid regime isabsolutely important. More frequent when on higherrates of infusion and in unstable patients
Do not depend solely on one parameter to decide onthe fluid status of the patient
Give the minimum volume required to maintain good
perfusion and urine output
Stop iv fluid therapy once out of critical phase and ishaemodynamically stable
