Fluid replacement in children with dengue and factors associated with pulmonary edema

ORIGINAL ARTICLE

Fluid Replacement in Children with Dengue and Factors Associated with Pulmonary Edema

Amit Dey, Harshal Dhabe, Dr Ira Shah.

Department of Pediatrics, B.J.Wadia Hospital for Children, Mumbai, India.

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Abstract
Objective: To determine fluid replacement and factors associated with pulmonary edema in children with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS).
Methods: This study was conducted over a period of 1 month in 32 children with DHF/DSS and a positive Dengue IgM capture ELISA. Intravenous (IV) fluid therapy was indicated when patient had hemoconcentration, poor capillary refill time, decreased urine output and/or hypotension or when child was unable to take orally. Fluids were adjusted according to the clinical condition, urine output and hematocrit. Statistical analysis was done to determine, complications of fluid therapy and factors associated with pulmonary edema.
Results: Mean age at presentation was 6 years with male:female ratio of 1:1. Fluids were given for an average of 52.1±34.6 hours in 30 patients. Two children did not require IV fluids as oral intake was satisfactory. Average fluids given were 2893.8±2838.2 ml with median of 1975 cc. Total fluids per kilogram of body weight were 143.7cc/kg±103.5 cc/kg. The urine output on Day1 of hospitalization was 2±0.7cc/kg/hour which increased to 4.9±1.9cc/kg/hour. Pulmonary edema was seen in 9 children (28%) and was related to more hours of intravenous fluids (82±41.4 hours Vs 39.3± 22hours; p=0.0009), more quantity of fluid (4649.7cc±3775.3cc Vs 2206.7±2100.7cc; p=0.06). All children with pulmonary edema had shock initially (p=0.0018). However there was no difference in time interval to recovery in children with/without pulmonary edema (p=0.134). Two children had acute respiratory distress syndrome (ARDS) which was not related to fluids, pulmonary edema and shock. Thirty one (97%) children recovered with average recovery time of 5.8±3.5 days and 1(3%) died.
Conclusion: Longer duration of fluid therapy and larger quantity of fluids can lead to pulmonary edema. Pulmonary edema is seen in patients with DSS. Thus judicious management of fluids and DSS is required to minimize complications of fluid overload states.

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