Peritoneal Dialysis in Dengue Shock Syndrome May Be Detrimental

Dengue shock syndrome is the most severe form of Dengue that can be fatal. Nonresponders to standard therapy need intensive care. This paper outlines the clinical features, complications, and outcomes of Dengue Shock Syndrome not responding to standard therapies and needing supportive care in a tertiary referral intensive care unit of a developing country. Nearly one-third die within 3 days of admission to ICU. Peritoneal dialysis predicts the worst outcomes. 1. Introduction Dengue is an important arthropod-borne viral disease of humans [1]. Its presentation varies from a mild viral syndrome to hemorrhagic fever and severe shock. Its severe forms (hemorrhagic fever and shock syndrome) may lead to multiorgan involvement and death. Dengue Shock Syndrome (DSS) is characterized by a massive increase in systemic capillary permeability with consequent hypovolemia [2]. The mortality rate in Dengue Shock Syndrome ranges from 6 to 30 percent, most commonly reported in children. Fluid resuscitation is critical with added support for failing organs [3]. In the recent past, Sri Lanka has experienced a surge of the disease reaching epidemic proportions associated with a probable change in the virus strain to a more virulent form [4, 5]. In this context we have also noted a rise in the number of cases with severe forms of the disease needing intensive care. The Peradeniya ICU is a tertiary referral centre and it attracts a large number of above patients with Dengue Shock Syndrome in the region who do not respond to standard therapy with intravenous fluids, antibiotics, and supportive care including inotropes. 2. Methods We collected demographic data of all patients referred for intensive care between January 2009 and June 2010 (18 months) and analyzed their outcomes in relation to the complications of DSS that ensued during their ICU stay and the therapies given. The diagnosis of Dengue has been established upon clinical grounds (WHO guidelines 2009) and treated accordingly by the referring physicians before admission to the ICU. On admission to ICU, all have had fever, vomiting 78%, abdominal pain 21%, cough 5%, and body ache among 3% of cases. Eleven patients have had serological tests and Dengue IgM was found to be positive amongst 72% and IgG in 50% of the tested. They all have had intravenous fluid therapies and antibiotics. During the course of therapy in ICU, 43.6% of cases received fresh frozen plasma, 21.8% cryoprecipitate, 32.7% blood, and 56.4% platelet transfusions. Furthermore, 36.4% of cases were mechanically ventilated for multiple reasons such as