%0 Journal Article
%T Should colloid boluses be prioritized over crystalloid boluses for the management of dengue shock syndrome in the presence of ascites and pleural effusions?
%A Ranjan Premaratna
%A Erandi Liyanaarachchi
%A Mindu Weerasinghe
%A H Janaka de Silva
%J BMC Infectious Diseases
%D 2011
%I BioMed Central
%R 10.1186/1471-2334-11-52
%X We highlight three patients with DSS who received boluses of crystalloids on priority basis as recommended by WHO guidelines during resuscitation. All three patients had varying degrees of third space fluid loss (ascites and pleural effusions) at the time of development of DSS. Ascites and pleural effusions were detected in all 3 patients at the time of shock irrespective of whether iv fluids were given or not. All three patients had documented liver involvement at the time of shock evidenced by elevation of AST (4800 iu/L, 5000 iu/L and 1960 iu/L). One patient who had profound shock died 6 hours after admission with evidence of acute pulmonary oedema in the convalescence phase. All of them needed CPAP ventilator support and potent diuretics.We therefore feel that resuscitation of patients with DSS who already have third space fluid accumulation with crystalloid boluses on priority basis may contribute to recovery phase pulmonary oedema.Dengue fever poses a major challenge to clinicians practicing in areas endemic for the infection. The presence of four serotypes, immunity related subsequent enhancement in severity, inadequate understanding of the pathophysiology of severe infection [1,2], absence of specific treatment, overcrowding in hospitals, inadequate laboratory facilities, delayed admissions due to patient ignorance and delayed diagnosis all contribute to the associated morbidity and mortality.The diagnosis and management of severe dengue fever (DF), dengue shock syndrome (DSS) and dengue haemorrhagic fever (DHF) are based mainly on clinical and haematological parameters [3-5]. The WHO guidelines which were practiced until September 2009 [3,4] and the revised guideline which was published subsequently [5], highlight the importance of packed cell volume (PCV) and haemoglobin levels when deciding the quantity and the type of fluid replacement. Although all three guidelines consider third space fluid accumulation, such as, pleural effusions and ascites, in the d
%U http://www.biomedcentral.com/1471-2334/11/52