Paediatrica Indonesiana

VOLUME 49

November 

NUMBER 6

Original Article

Comparison of blood plasma and gelatin solution in

resuscitation of children with dengue shock syndrome
Suryadi Nicolaas Napoleon Tatura, Novie Homenta Rampengan, Jose Meky Mandei, Ari
Lukas Runtunuwu, Max FJ Mantik, Tony Homenta Rampengan

Abstract
Background'HQJXHVKRFNV\QGURPH'66LVFKDUDFWHUL]HGE\
VHYHUHYDVFXODUOHDNDJHDQGKHPRVWDVLVGLVRUGHU,WLVWKHFDXVHRI
GHDWKLQWRSHUFHQWRIFDVHV:+2PDQDJHPHQWJXLGHOLQHVIRU
UHVXVFLWDWLRQUHPDLQHPSLULFDOUDWKHUWKDQHYLGHQFHEDVHG
Objective 7R ILQG RXW WKH DOWHUQDWLYH IOXLGV WR UHSODFHSODVPD
leakage in DSS.
Methods :H SHUIRUPHG D SURVSHFWLYH VWXG\ DQG UDQGRPL]HG
comparison of plasma and gelatin solution for resuscitation of
,QGRQHVLDQFKLOGUHQZLWK'66:HUDQGRPO\DVVLJQHGVXEMHFWV
ZLWK'66WRUHFHLYHSODVPDDQGFKLOGUHQWRUHFHLYHJHODWLQ
IOXLG 6WDWLVWLFDO DQDO\VH ZHUH SHUIRUPHG XVLQJ FKLVTXDUH WHVW
)LVKHUVH[DFWWHVWWWHVW0DQQ:KLWQH\WHVW
Results7KHLQFUHPHQWRISXOVHSUHVVXUHZLGWKDQGWKHGHFUHPHQW
RIKHPDWRFULWLQVXEMHFWVWUHDWHGZLWKJHODWLQZHUHKLJKHUWKDQ
WKDWRISODVPDDWIRXUKRXUWKHUDS\3 DQG3 2QO\
RQHSDWLHQWGLHGFDXVHGE\XQXVXDOO\PDQLIHVWDWLRQRI'667KH
LQFUHPHQWRIERG\WHPSHUDWXUHLQVXEMHFWVWUHDWHGZLWKSODVPDZDV
KLJKHUWKDQWKDWRIJHODWLQDWIRXUKRXUWKHUDS\3 7KH
GHFUHPHQWRISODWHOHWFRXQWLQVXEMHFWVWUHDWHGZLWKJHODWLQZHUH
OHVVWKDQWKDWRISODVPD3 7KHLQFUHPHQWRIGLXUHVLVUDWH
LQVXEMHFWVWUHDWHGZLWKJHODWLQZDVKLJKHUWKDQWKDWRISODVPDDW
WZHQW\KRXUWKHUDS\37KHGHFUHPHQWRIUHVSLUDWRU\
UDWHLQVXEMHFWVWUHDWHGZLWKJHODWLQZDVKLJKHUWKDQWKDWRISODVPD
DWWZHQW\HLJKWKRXUWKHUDS\3 7KHUHZDVQRGLIIHUHQFH
in studied variables : total volume rate, blood pressure, pulse rate,
UHVKRFNUDWHFOLQLFDOIOXLGRYHUORDGDOOHUJ\UHDFWLRQVEOHHGLQJ
PDQLIHVWDWLRQVDQGOHQJWKRIVWD\3!
Conclusions Gelatin solution can be used as volume replacement
in resuscitation of DSS if blood plasma is not available especially
DWIRXUKRXUWKHUDS\[Paediatr Indones. 2009;49:322-9]
Keywords: Dengue shock syndrome, resuscitation,
gelatin, plasma.

322Paediatr Indones, Vol. 49, No. 6, November 2009

iagnosis of dengue hemorrhagic fever

'+)LVEDVHGRQGLDJQRVLVFULWHULRQRI
:+2 Dengue shock syndrome
'66LVDVHYHUHPDQLIHVWDWLRQRI'+)
,WLVDKHDOWKSUREOHPLQWURSLFDO$VLDDQG$PHULFD
ZKLFKFDXVHVPRUELGLW\DQGPRUWDOLW\LQFKLOGUHQDQG
'+)DFFRPSDQLHGZLWKVKRFNLVVWLOODQHPHUJHQF\
SUREOHP LQ ,QGRQHVLD DQG LW LV WKH PDLQ FDXVH RI
death.,Q6DUGMLWR+RVSLWDOWKHUHZDVSDWLHQW
IRXQGGHDWKZLWK'66JUDGH,,,DQGSDWLHQW
ZLWK'66JUDGH,9VLQFHWR6:RUOG+HDOWK
2UJDQL]DWLRQ :+2 UHSRUWV WKH PRUWDOLW\ UDWH RI
'66DPRQJFKLOGUHQZDVWRSHUFHQWV8
Prompt restoration of the volume plasma
circulation is the cornerstone of DSS therapy due
to the poorly understood of the pathophysiology
and mechanisms underlying the vascular leakage,
therefore no specific treatment is available. 4,8
:+2 PDQDJHPHQW JXLGHOLQHV ILUVW SURSRVHG LQ
UHFRPPHQGFU\VWDOORLGVROXWLRQVLQLWLDOO\DVD

From the Department of Child Health, Medical School, Sam Ratulangi

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Reprint request to6XU\DGL1LFRODDV1DSROHRQ7DWXUD0''HSDUWPHQW
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+RVSLWDO-O5D\D7DQDZDQJNR0DQDGR,QGRQHVLD7HOS
)D[(PDLOUDQXEHGDOL#\DKRRFRP

Suryadi Tatura et al: Plasma vs gelatin solution in DSS

UHSODFHPHQW RI SODVPD ORVV IROORZHG E\ EROXVHV RI

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7KHRUHWLFDOO\ EORRG SODVPD WKHUDS\ LV LGHDO IRU WKH
vascular leakage, but it has disadvantages such as
transmitting diseases, allergic reactions, anaphylactic
UHDFWLRQVJUDIWYHUVXVKRVWGLVHDVH,QDGGLWLRQWRWKH
OLPLWDWLRQRI,QGRQHVLDQ5HG&URVV,5&SURYLGLQJ
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areas.2QWKHRWKHUKDQGQRZDGD\VWKHUHDUHVWLOO
difficulties to find proper donors in immediate time.
7KHUHIRUH DOWHUQDWLYH VROXWLRQV VXFK DV V\QWKHWLF
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have adverse effects on coagulation factor, renal, liver,
and fluid accumulation.
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LV D FROORLG WKDW XVHG WR UHVXVFLWDWH SDWLHQWV ZLWK
hypovolemic shock.:+2XVHJHODWLQVROXWLRQDV
one of colloids for DSS management. Nhan et al
reported that gelatin solution for DSS resuscitation
in Southern Vietnam is better than Ringer lactate
and normal saline to recover pulse pressure. Gelatin
solution is better than Starch and Dextran
solution base on anaphylactic reactions, coagulations
effects, renal dysfunction, liver dysfunction or fluid
accumulation. &RPSDUH ZLWK SODVPD JHODWLQ
has no adverse effects such as transmitting diseases,
JUDIW YHUVXV KRVW GLVHDVH ,W LV FKHDSHU WKDQ SODVPD
DQGHDV\WRSURYLGHDWDQ\WLPH:HWHVWHGZKHWKHU
blood plasma could be replaced by gelatin solution if
EORRGSODVPDZDVQRWDYDLODEOH+RZHYHUZHXVHGWKH
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IRUSULPDU\UHVXVFLWDWLRQIROORZHGE\FROORLGVXFKDV
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ZLWK '66 LQ 5' .DQGRX +RVSLWDO LQ 0DQDGR
,QGRQHVLD

Methods
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comparison of blood plasma and gelatin solution for
IOXLG UHVXVFLWDWLRQ RI FKLOGUHQ ZLWK '66 DQG LW ZDV
conducted in the pediatric intensive care unit from
)HEUXDU\WR0D\DWWKH5'.DQGRX+RVSLWDO
LQ 0DQDGR ,QGRQHVLD *HODWLQ VROXWLRQ XVHG ZDV
JHORIXVLQ VROXWLRQ DQG EORRG SODVPD ZDV SURYLGHG
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FULWHULDZHUHDOOSDWLHQWGLDJQRVHGDV'66'+)JUDGH

,,, ,9EDVHGRQ:+2FULWHULD, the parents

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of hypersensitivity of blood transfusion and gelatin
VROXWLRQRUZKR KDGEHHQJLYHQIOXLGUHVXVFLWDWLRQ
ZLWKFU\VWDOORLGDQGRUFROORLGEHIRUHDGPLWWHGWRWKH
KRVSLWDORUUHMHFWHGWRSDUWLFLSDWHLQWKHVWXG\ZHUH
H[FOXGHG 7KH VWXG\ SURWRFRO ZDV DSSURYHG E\ WKH
Ethics Committee of the hospital.
Clinical procedures 7KH SDWLHQWV ZHUH
randomly assigned to receive either plasma or gelatin
VROXWLRQ$WWKHEHJLQQLQJRIWKHVWXG\ZHUHFRUGHG
demographic data, history (duration of fever, bleeding
manifestation, vomits, abdominal pain, diarrhea,
KHDGDFKHH[DPLQDWLRQILQGLQJVJHQHUDOFRQGLWLRQ
consciousness, blood pressure, pulse pressure, pulse
UDWH UHVSLUDWRU\ UDWH ERG\ WHPSHUDWXUH OLYHU VL]H
ODERUDWRU\ILQGLQJVKHPDWRFULWSODWHOHWFRXQW,J0
DQG ,J* 5DSLG 6WULS 7HVW DQG EORRG FRPSDWLELOLW\
WHVWFURVVPDWFKZDVGRQHWRSUHSDUHEORRGSODVPD
DQGZKROHEORRGIRUWUDQVIXVLRQDQGH[DPLQHGEORRG
ureum and creatine.
7KH SDWLHQW ZDV JLYHQ 5/ VROXWLRQ  PONJ
LPPHGLDWHO\ LQ  PLQXWH PD[LPXP XQWLO  WKH
SDWLHQWZDVQRWLQVKRFNSXOVHSUHVVXUH!PP+J
DQGFRXOGEHUHSHDWHGRQFHPRUHLIWKHSDWLHQWZDV
still in shock. After pulse pressure !PP+JZH
performed physical examination (general condition,
consciousness, blood pressure, pulse pressure, pulse
UDWHUHVSLUDWRU\UDWHERG\WHPSHUDWXUHOLYHUVL]HDQG
ODERUDWRU\H[DPLQDWLRQKHPRWRFULWEHIRUHVWDUWLQJ
WRVWXG\WKHIOXLG+R7KHQHDFKVXEMHFWZDVJLYHQ
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RYHURQHKRXUSHULRGIROORZHGE\5/VROXWLRQRI
PONJKRXUXQWLOWKHVXEMHFWZDVVWDEOHLQKRXUV
maximum. Blood pressure, pulse pressure, pulse rate,
UHVSLUDWRU\ UDWH ERG\ WHPSHUDWXUH GLXUHVLV ZHUH
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entry or in the event of cardiovascular deterioration.
3ODWHOHWFRXQWZDVPHDVXUHGHYHU\DQGKRXUV
Fluid overload manifestation (palpebral edema,
DVFLWHVURQFKLLRUZKHH]LQJRQERWKOXQJZHUHDOVR
PRQLWRUHGHYHU\WLPH7KHSDWLHQWZDVVWDEOHV\VWROLF
blood pressure !PP+JSXOVHSUHVVXUH!PP+J
diuresis !PONJKRXUDQGKHPDWRFULWIRU
DWOHDVWKRXUV5/PONJKRXUGHFUHDVHGWRPO
NJKRXU[KRXUVPLQLPXPWKHQWRPONJKRXU

Paediatr Indones, Vol. 49, No. 6, November 2009323

Suryadi Tatura et al: Plasma vs gelatin solution in DSS

Statistical analysis:
Whitn ey test

at-test, bchi-square

2.0

90.00
100.00

90.00
100.00

76.67
70.00

76.75
70.00

48
42

48
41

69.48

67.00

test, cFishers exact test, dMann-

324Paediatr Indones, Vol. 49, No. 6, November 2009

Gelatin

Plasm a

40
30
20
10
0

At 4 hour, Mann-Whitney test, p<0.01

48

2.0

44

3
0
4
0

40

3
0
0
2

36

32

$GPLQLVWUDWLRQRIDOOWKHIOXLGW\SHVVKRZHGVLJQLILFDQW
improved hemodynamic variable, such as systolic
blood pressure, diastolic blood pressure, pulse pressure,
pulse rate, hematocrit and diuresis on both groups. For
pulse pressure variable, t significant difference such
DVKLJKHULQFUHDPHQWRIWKHZLGWKRISXOVHSUHVVXUH
in subjects received gelatin than that of plasma
DW IRXUKRXU WKHUDS\ XVLQJ 0DQQ:KLWQH\ WHVW
3 Figure 1DQGUHPDLQHGVWDEOHXQWLOKRXU

28

0
19

24

0
21

Hemodynamic variables

20

7.1
13
22.71

16

6.9
12
22.06

Gelatin
(N=25)

12

Age (yr)
Mean
Male Sex
Body weight (kg)
Ab response
Primary
Secondary
Day of illness at shock (day)
Mean
Bleeding manifestation (mucous)
Epistaxis
Hematemesis
Mean
Bleeding gum
Liver size (cm)
Mean
Systolic blood pressure (mmHg)
Mean before RL 20 ml/kg
Mean after RL 20 ml/kg
Diastolic blood pressure(mmHg)
Mean before RL 20 ml/kg
Mean after RL 20 ml/kg
Hematocrit %
Mean before RL 20 ml/kg
Mean after RL 20 ml/kg
Platelet count x103 /mm3
Mean

Plasma
(N= 25)

'XULQJ)HEUXDU\WR0D\DWRWDORIVXEMHFWV
ZHUHUHFUXLWHGLQWKHVWXG\DQGDOOKDGUHFHLYHGWKHLU
GHVLJQHG VWXG\ IOXLG )URP  VXEMHFWV RQH VXEMHFW
dropped out of complications (dengue encephalopathy,
SXOPRQDU\HGHPDDQGPDVVLYHEOHHGLQJ2XWRI
VXEMHFWVRIWKHPUHFHLYHGEORRGSODVPDDQGRWKHU
 UHFHLYHG JHODWLQ VROXWLRQ DQG DOO RI WKHP IXOO\
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ZHOOEDODQFHGDPRQJWKHIOXLGWUHDWPHQWJURXSVDQG
WKHUH ZHUH QR VLJQLILFDQW GLIIHUHQFH EHWZHHQ SODVPD
group and gelatin solution group (Table 1
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ZDVDSSUR[LPDWHO\PONJ,WZDVWKHVDPHDVWKRVH
WKDWZHUHXVHGE\JHODWLQVROXWLRQJURXSTable2

Characteristics

Results

H
A
St
ar
t

Table 1. Baseline characteristics of study subjects

VXFK DV V\VWROLF EORRG SUHVVXUH GLDVWROLF EORRG

pressure, pulse pressure, pulse rate, respiratory rate,
body temperature, hematocrite, diuresis, decreased
SODWHOHWFRXQWWRWDOIOXLGYROXPHWKHVXEMHFWVOHQJWK
of stay in the hospital and blood plasma or gelatin
VROXWLRQ LQ '66 SDWLHQWV ZH XVHG WWHVW RU 0DQQ
:KLWQH\WHVW7KHILUVWVWHSZDVWKDWZHSHUIRUPHG
GDWDQRUPDOLW\WHVWXVLQJ.ROPRJRURY6PLUQRYWHVW

Mean of PP

[ KRXUV PLQLPXP WKHQ WR  PONJKRXU [

KRXUVPLQLPXPDQGGHFUHDVHGWRGULSVPLQXWH
:KHQHYHUVXEMHFWVEHFDPHXQVWDEOHEORRGSODVPDRU
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DGPLQLVWHUHG6XEMHFWVZKRKDGUHVKRFNZHUHJLYHQ
5/PONJLPPHGLDWHO\6XEMHFWVZKRKDGVHYHUH
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blood transfusions, diuretics and other therapy could
be given depend on clinical condition.
Outcome measurements 'DWD ZHUH UHFRUGHG
VLQFHWKHVXEMHFWVZHUHDGPLWWHGWRWKHKRVSLWDODW
WKDWWLPHVXEMHFWVZRXOGKDYHUHFHLYHG5/PONJ
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Statistical analysis$OOGDWDZHUHSURFHVVHGDQG
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DQDO\]HWKHFRPSDULVRQEHWZHHQJHQHUDOH[DPLQDWLRQ

Tim e of evaluation every 4 hour

Figure 1 Curve of pulse pressure in gelatin group

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Suryadi Tatura et al: Plasma vs gelatin solution in DSS

Table 2. Main Outcome Measurements
Characteristics
6QVCNXQNWOGQHKXWKFKPHWUKQP
ONMI
Mean
Platelet count (x 103 cells/mm3)
/GCPDGHQTGWKFUVTGVOGPV
Mean after treatment 12 hour
Mean of decreased in 12 hour
Re-shock state
Number of reshock
Average time to reshock (hour)
%NKPKECNWKFQXGTNQC
Allergic reactions
Mild
Severe
Bleeding manifestation (mucous)
Epistaxis
Hematemesis
Melena
Bleeding gum
Lengh of hospital stay (day)
Mean

Plasma
(N= 25)

Gelatin
(N=25)

140

140

0.389a

69.48
37.04
32.44

67.00
46.96
20.12

0.670b
0.048b
0.018b

1
20
2

0
0
0

1.000c
----0.490c

1
1

1
0

1.000c
1.000c

0
0
3
1

0
0
2
0

------0.235c
0.490d

3.00

3.00

0.389a

Statistical analysis: aMann-Whitney test, bt-test, cFishers exact test, dchi-square test,

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)URP WKH KHPDWRFULW YDULDEOH WKHUH ZDV DOVR
significant difference in higher decreament of
hematocrit, in subjects received gelatin than than that
RISODVPDDWIRXUKRXUWKHUDS\XVLQJ0DQQ:KLWQH\
WHVW3 Figure 2
Plasm a

48

44

40

36

28

32

24

20

16

12

St

At 4 hour, Mann-Whitney test, p=0.017

ar
t

Mean of hematocrit

Gelatin
60
50
40
30
20
10
0

Tim e of evaluation every 4 hour

Figure 2. Curve of hematocrite in gelatin and plasma

ITQWRUFWTKPIWKFUVTGCVOGPV

Mean of diuresis

Gelatin

Plasm a

Hematologic Variable
2XW RI  VXEMHFWV ZLWK '66 WKHUH ZHUH ORZHU
decreament of platelet count in gelatin solution group
WKDQWKDWLQSODVPDJURXSmm3DQG
mm3XVLQJWWHVW3 Tabel 2

Possible complications of fluid treatment

6
5
4
3
2
1
0

Different from previous hemodynamic variables,

GLXUHVLVYDULDEOHZDVMXVWVLJQLILFDQWO\GLIIHUHQWDIWHU
KRXUWKHUDS\DQGFXOPLQDWLQJDWKRXUWKHUDS\
Gelatin solution group had higher diuresis rate than
that of plasma group in convalescent phase, using
0DQQ:KLWQH\WHVW3Figure 3
1HYHUWKHOHVVWKHUHZDVQRVLJQLILFDQWGLIIHUHQFH
EHWZHHQSODVPDDQGJHODWLQVROXWLRQJURXSVLQV\VWROLF
blood pressure variable (Figure 4 GLDVWROLF EORRG
pressure (Figure 5 RU SXOVH UDWH Figure 6 XVLQJ
0DQQ:KLWQH\WHVWDQGWWHVW3!

At 20 hour, Mann-Whitney test, p=0.000

4

12
16
20
Tim e of evaluation every 4 hour

24

Figure 3. Curve of diuresis in gelatin and plasma

ITQWRUFWTKPIWKFUVTGCVOGPV

5HFXUUHQW VKRFN ZDV UHFRUGHG RQO\ LQ RQH VXEMHFW

UHFHLYLQJEORRGSODVPDDWKRXUWUHDWPHQW&OLQLFDO
IOXLGRYHUORDGZHUHIRXQGLQWKUHHVXEMHFWVUHFHLYLQJ
EORRGSODVPDZKRZHUHWUHDWHGZLWKIXURVHPLGH2QH
RIWKHVLJQRIFOLQLFDOIOXLGRYHUORDGZDVWKHLQFUHPHQW
RIUHVSLUDWRU\UDWH'HFUHDVHGUHVSLUDWRU\UDWHGXULQJ
WKHUDS\LQGLFDWHGWKHUHZHUHLPSURYHPHQWRIFOLQLFDO

Paediatr Indones, Vol. 49, No. 6, November 2009325

Suryadi Tatura et al: Plasma vs gelatin solution in DSS

105
100
95
90
85

Plasm a

48

44

40

36

32

24

28

20

16

12

All hours, Mann-Whitney test, p>0.05

H
A
St
ar
t

Mean of SBP

Gelatin

Tim e of evaluation every 4 hour

Figure 4. Curve of systolic blood pressure in gelatin

and plasma groups
Gelatin

Plasm a

75
70
65

48

40

44

36

32

28

24

16

20

12

ar
St

All hours, Mann-Whitney test, p>0.05

60

Mean of DBP

80

Tim e of evaluation every 4 hour

Figure 5. Curve of diastolic blood pressure in gelatin

and plasma groups
Plasm a

44

48

40

36

32

24

28

20

16

12

St

ar
t

140
120
100
80
60
40
20
All hours, Mann-Whitney, p>0.05
0

Mean of pulse rate

Gelatin

Tim e of evaluation every 4 hour

Figure 6. Curve of pulse rate in gelatin and plasma

groups
Plasm a

48

44

40

36

32

28

24

20

16

12

30
29.5
29
28.5
28
27.5
27
26.5
26 At 28 hour, Mann-Whitney, p=0.018
25.5

H
A
St
ar
t

Mean of respiratory rate

Gelatin

Tim e of evaluation every 4 hour

Figure 7. Curve of respiratory rate in gelatin and plasma

groups
Plasm a

48

44

40

36

32

28

24

20

16

12

At 4 hour, t-test, p=0.011

rt

H
A

37
36.8
36.6
36.4
36.2

St
a

Mean of BT

Gelatin

Tim e of evaluation every 4 hour

Figure 8. Curve of body temperature in gelatin and

plasma groups

326Paediatr Indones, Vol. 49, No. 6, November 2009

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JHODWLQJURXSGXULQJWKHUDS\ZKLFKZDVVLJQLILFDQWO\
KLJKHU WKDQ WKDW LQ SODVPD JURXS DW  KRXUV LQ
convalescent phase (Figure 7
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:KLWQH\WHV3 7KUHHVXEMHFWVLQWKHVWXG\
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fever developed in one subject in each of both
groups as mild allergic reaction and one subject
had severe allergic reaction (urticarial rash, fever
and dropped blood pressure after receiving blood
SODVPD$OOKDGEHHQWUHDWHGE\RUDODQWLKLVWDPLQHV
IRU PLOG DOOHUJLF UHDFWLRQ DQG GLSKHQK\GUDPLQH
HCl intravenously for severe allergic reaction
(Table 2 'XULQJ WKH VWXG\ DQ H[FHVV RI IHEULOH
UHVSRQVHRFFXUUHGLQSODVPDJURXS,QFUHDVHGERG\
WHPSHUDWXUH LQ SODVPDJURXS ZDV VLJQLILFDQWO\
KLJKHU WKDQ JHODWLQ VROXWLRQJURXS HVSHFLDOO\ DW
IRXUKRXUWUHDWPHQWFigure 8).
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LQ SODVPDJURXS WZR VXEMHFWV LQ JHODWLQ VROXWLRQ
JURXS %OHHGLQJ JXP ZDV UHFRUGHG LQ RQH VXEMHFW
LQ SODVPD JURXS (SLVWD[LV DQG KHPDWHPHVLV ZHUH
not found in both groups (Table 2 +RZHYHU
WKHUHZHUHQRVLJQLILFDQWGLIIHUHQFHDPRQJWKHIOXLG
WUHDWPHQWJURXSVLQWKHGHYHORSLQJRIQHZEOHHGLQJ
manifestation, clinical fluid overload, and allergic
UHDFWLRQ3!Table 2
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3!Table 2

Discussion
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a marked reduction in the mortality rate in the best
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intravenous fluid should be used.
Colloid solution is usually given to prevent
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that occurred before six hours from the onset of the

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compared blood plasma as natural colloid and gelatin
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the benefits and side effects of each fluids in the
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manifestation development, clinical fluid overload,
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blood pressure, decreased diastolic blood pressure and
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both substances. Gelatin has four hours of half life
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previous studies, Dung et al reported increased pulse
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hour of resuscitation. Nhan et al reported pulse
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as dextran and better than RL and normal saline.
Pulse pressure is the most significant factor
predicting the clinical response to resuscitation in
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reported by Nhan et alDWRQHKRXUWUHDWPHQW
and by Dung et al DW WZRKRXU WUHDWPHQW 
Different methods in these studies caused different
results in hematocrit decrements including our study.
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XQWLOWKHth hours, causing significant difference to
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Current theories of microvasculer ultrafiltration
support the basic Starling principle of a balanced
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pressure, but postulate the glycocalyx, rather than the
endothelial cells, to be the major regulator of fluid

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particularly albumin, absorbed to positive residues
in the glycocalyx layer and restrict ultrafiltration.8
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study reported by Samsi et al. Samsi et al found that
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cells consumption.
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solution is better than blood plasma to stabilize
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plasma recipient in convalescent phase and caused
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treatment.
During study, side effects of allergic reaction

Paediatr Indones, Vol. 49, No. 6, November 2009327

Suryadi Tatura et al: Plasma vs gelatin solution in DSS

occurred in both groups. One mild allergic reaction

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allergic reaction in plasma group. Allergic reaction in
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in anaphylactic reaction to gelatin urea linked and
polygeline. Darell et al reported number of allergic
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reported that incidence of allergic reaction in gelatin
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recipient might be caused by either bacterial or non
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and gelatin solution. Gelatin solution can be used as
volume replacement in DSS resuscitation if blood
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treatment. On the other side, Gelatin is cheaper than
plasma and it is relatively available at any time.



4.













Acknowledgments



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study and their parents.
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to disclose





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Jastremski MS, Syverut SA, editors. Emergency drug therapy.
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Paediatr Indones, Vol. 49, No. 6, November 2009329