Dengue in children

fainting are ominous signs. In those cases, fluids should be aggressively given at 20 ml/kg 0.9 normal saline solution in less than one hour and repeated once if no improvement is noted.
If after bolus infusion the patient continues with evidence of hypoperfusion or increasing hematocrit is observed, colloids should be given according to platelet count and coagulation profile status (fresh frozen plasma or 5 percent of plasma protein fraction (i.e. Plasmanate or albumin) at 10 ml/kg.  The use of colloids should be considered cautiously due to the risk of pulmonary congestion. Inotropics should also be started if no improvement is noted.
When a patient shows hypoperfusion signs together with decreasing hematocrit, internal bleeding should be considered. Such patient is in critical condition, requiring aggressive blood volume expansion and blood products transfusion according to needs.
The use of intravenous immuneglobulin and corticosteroids in the management of Dengue is still in debate.  Currently, we are not using this approach, even in severe cases.   An algorithm of the above mentioned approach is presented on page 3.
The previous article represent a consensus management of the following consultants: Alicia Fernández-Sein, MD, José G. Rigau, MD, Sandra Somohano, MD, Enid Rivera, MD, Annette Santiago, MD, Ana Córdova, MD, Fernando Rodriguez, MD, Gilberto Puig, MD, Milagros Pumarejo, MD, Jose Rodriguez-Santana, MD

References:

  1. World Health Organization. Dengue and Dengue hemorrhagic fever in the Americas. Guidelines for Prevention and Control.  Scientific Publication No.548.
  2. Kalayanarooj S.,et al. Early clinical and laboratory indicators of acute dengue illness.  J of lnfect Dis 1997;l76:313-321.
  3. Lum LCS. Management of dengue hemorrhagic fever/dengue shock syndrome. Malaysian J Pathol 1993; 15(1): 29-33.
  4. Nimmannitya S. Dengue hemorrhagic fever: Diagnosis and management. In Gubler D.J.and Kuno G., (eds). Dengue and Dengue hemorrhagic fever, CAB International 1997
    5.

Hot Topics in Pediatric Critical Care       Sandra Somohano, MD / Alicia Fernandez-Sein ,MD

Fluid overload and furosemide drips
Positive fluid balance in critically ill patients is a common problem in the ICU. It is often associated with poor outcome, prolonged mechanical ventilation and increased incidence of nosocomial infections. Colloid infusions, fluid restriction, inotropic support and conventional intermittent diuretic therapy are sometimes ineffective in reversing this phenomenon.
Continuous furosemide drip (0.1 - 0.75 mg/kg/hr) has been successful in relieving fluid overload states with minimal side

effects (i.e. hypokalemia). In spite of our present euphoria with this type of therapy, further studies are needed to define proper patient selection, pediatric dosage and therapeutic goals. There is also lack of uniformity on the way the drip is handled.  For example, prior bolus, increasing and decreasing rates, and required monitoring.  It's use must be accompanied by close monitoring of vital signs and serum electrolytes.  Careful attention must be paid to water balance.  Of course, we should never forget other more invasive, but effective procedures, such as hemodialysis and/or hemofiltration.