2010 Interim guidelines on fluid management of dengue.pptx

7/30/2019 2010 Interim guidelines on fluid management of dengue.pptx

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2010 INTERIM

GUIDELINES ON FLUIDMANAGEMENT OF

DENGUE FEVER AND

DENGUE HEMORRHAGICFEVER

John Paul L. Oliveros, MD, DPPS


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Objectives

To compare the dengue case classification

used in the 2008 PPS Dengue evidence-

based 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


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Dengue Case Classification


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Fluid Management

DF/DHF (Dengue without danger signs) who

are not admitted

ORS should be given

Reduced osmolarity (Na+ 45-60mmol/L Sports drinks (Na+ < 20meqs) should not be given


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Fluid Management

Admitted patient without shock (DF/DHF I-II or

dengue without warning signs)

Isotonic solutions

D5LR, D5NSS, D5 0.9NaCl

Maintenance rate


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Fluid Management

Admitted Patients with some dehydration but

without shock


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Fluid Management

Admitted patients with some dehydration but

without shock


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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


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Clinical Parameters


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Annotations

If hematocrit is not available, assesshemodynamic status

Assessment of improvement should be based on7 parameters

Mental status Heart rate

Blood pressure

Respiratory rate

Capillary refill time Peripheral blood volume

extremities


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Annotations

Safe

effective as colloidsin reducing shock

and mortality

1

st

line inmoderately

severe/compensate

d shock

Increased risk of

allergic reactions Increased risk of

new bleeding

manifestations

More expensive

Crystalloids Colloids


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Annotations

0.9% saline (normal saline)/NSS

Repeated large volumeslead to hyperchloremicacidosis

Ringers lactate Lower sodium and chloride

273 mOsm/L

May not be suitable forpatients with severehyponatremia

Avoided in liver failure andin patients takingmetformin

Dextrans

Bind to Von Willebrandfactor/Factor VIII complex

Impair coagulation the most

Potential to cause osmoticrenal injury in hypovolemicpatients

Starch

Gelatin Least effect on coagulation

Highest risk of allergicreactions among colloids

Crystalloids Colloids


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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: Epinephrine 5amps (5cc) + d5water 45ml=5mg/50ml

Formula: weight x dose (0.3-2mcg/kg/min) x 60= cc/hr100


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Annotations

HypotensionAdult: SBP


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Good Morning

Thank You

Documents

2010 Interim guidelines on fluid management of dengue.pptx