Professional Documents
Culture Documents
Objectives
To compare the dengue case classification used in the 2008 PPS Dengue evidencebased guidelines and the proposed 2009 WHO Dengue Guidelines To update the section on fluid management of the 2008 PPS Dengue evidence-based guidelines To develop clinical algorithms on fluid resuscitation of patients with dengue based on presenting clinical features and based on the presence of compensated and
Fluid Management
should be given
Reduced
osmolarity (Na+ 45-60mmol/L Sports drinks (Na+ < 20meqs) should not be given
Fluid Management
Admitted patient without shock (DF/DHF I-II or dengue without warning signs)
Isotonic
D5LR,
solutions
D5NSS, D5 0.9NaCl
Maintenance
rate
Fluid Management
Fluid Management
Fluid Management
Important Tips:
Periodic
assessment Monitor Clinical parameters and correlate with hematocrit IVF decreased anytime as necessary based on clinical assessment If patient shows signs of deterioration, manage as compensated shock or hypotensive shock
Clinical Parameters
Annotations
If hematocrit is not available, assess hemodynamic status Assessment of improvement should be based on 7 parameters
Mental status Heart rate Blood pressure Respiratory rate Capillary refill time Peripheral blood volume extremities
Annotations
Crystalloids
Colloids
Safe effective as colloids in reducing shock and mortality 1st line in moderately severe/compensate d shock
Increased risk of allergic reactions Increased risk of new bleeding manifestations More expensive
Annotations
Crystalloids
Colloids
Dextrans
Repeated large volumes lead to hyperchloremic acidosis Lower sodium and chloride 273 mOsm/L May not be suitable for patients with severe hyponatremia Avoided in liver failure and in patients taking metformin
Ringers lactate
Bind to Von Willebrand factor/Factor VIII complex Impair coagulation the most Potential to cause osmotic renal injury in hypovolemic patients
Starch Gelatin
Annotations
Inotropes
Dopamine:
Dopamine 200mg/5ml + d5water 245ml= 200mg/250ml Premixed: 200mg/250ml; 400mg/250ml Formula: weight x dose (5-20mcg/kg/min)x 0.075 = cc/hr
Dobutamine:
Dobutamine 250mg/20ml or 12.5mg/ml amp (20cc) + d5water 230 cc= 250mg/250ml Premixed: 250mg/250ml; 500mg/5ml Formula: weight x dose (5-20mcg/kg/min) x 0.06= cc/hr
Epinephrine 5amps (5cc) + d5water 45ml=5mg/50ml Formula: weight x dose (0.3-2mcg/kg/min) x 60= cc/hr
100
Epinephrine:
Annotations
Hypotension
Adult: SBP <90mmHg or MAP <70mmHg or decrease in SBP >40 mmHg of <2 SD below normal for age Children <10yo:
Urine Output
Good urine output indicates sufficient circulatory volume Index or guide for decreasing the amount of fluid administered 0.5-1cc/kg/hr Monitor q hourly until out of shock then q 2 hrs Serum creatinine if acute renal failure is suspected
Thank You
Good Morning