No

Statement

Author/Publication

1

Monitor treatment and recovery IV resuscitation therapy ⁽³⁾ :

Acetated Ringer’s or 5% glucose (I PSS) at a rate of 10-20 ml/kg of body weight per hour (or as fast as possible).

• If shock persists after 20-30 ml/kg of body weight add a plasma expander at the rate of 10-20 ml/kg per hour.

• If shock persist significant internal bleeding should be suspected Continuation of intravenous therapy should be adjusted according to hematocrit and the rate should be reduced to 10 ml/kg per hour.

• In general there is no need to continue the therapy beyond 48 hours.

GUIDELINES

Clinical and Laboratory Guidelines for Dengue Fever and Dengue Haemorrhagic

 Fever/Dengue Shock Syndrome for Health Care Providers

2

Type of fluid in volume replacement in DHF ⁽⁴⁾ :

     Crystalloid:

• 5% dextrose in lactated Ringer’s solution (5% D/RL)

• 5% dextrose in Acetated Ringer’s solution (5% D/RA)

• 5% dextrose in half strength normal saline solution (5% D/1/2/NSS)

• 5% dextrose in normal saline solution (5% D/NSS)

     Colloidal:

• Dextran 40

• Plasma

Prevention and Control of Dengue and DHF: Comprehensive Guidelines; WHO, Regional Publication, SEARO, no. 29; New Delhi;

3

Because patients have loss of plasma (through increased vascular permeability into the serous spaces) they must be given isotonic solutions and plasma expanders, such as Acetated Ringer’s or lactated ringer's, plasma protein fraction, and Dextran 40 ⁽⁵⁾ .

P Amin*, Sweety Bhandare**, Ajay Srivastava***
*Consultant BHIMS, **Resident, Cook Country Hosp. Chicago. ***Resident, Bombay Hosp. Mumbai

4

In the critical stage, immediate volume replacement with isotonic solution such as normal saline (NSS), 5% D/NSS, lactated ringer's solution (RLS) or Acetated Ringer’s Solution (ARS), at a rate of 10-20 ml/kg/h in 1-2 hours, should be administered until circulation improves and an adequate urinary output is obtained ⁽⁶⁾.

Faculty of Tropical Medicine, Mahidol University. All rights reserved. Webmaster : tmwww@mahidol.ac.th

5

The result of studies from various places (Bangkok, Thailand, 2000) on the use of corticosteroid in treating DSS showed no benefit either in the fatality rate or any reduction in the volume of fluid therapy or duration of therapy. Solution for volume replacement: 5% D in NSS, 5% D in 1/2 NSS, Lactated Ringer's or Acetated Ringer’s, Plasma expander, Dextran 40 ⁽⁷⁾ .

WHO/SEARO Home © WHO Regional Office for South-East Asia 2009 All rights reserved

6

Acetated Ringer's Solution is often used for fluid resuscitation after a blood loss due to trauma, surgery, or a burn injury, as well as hypovolemic shock due to severe dehydration and dengue hemorrhagic fever. It is used because the byproducts of acetated ringer's metabolism counteract acidosis, a chemical imbalance that occurs with acute fluid loss, such as occurring in diarrhoea. The metabolism of acetated ringer's is mainly in muscle and 2.5 to 4 times faster than lactated ringer's (see lactated Ringer's solution) ⁽⁸⁾ .

www.medic8.com

© Medic8 ® All Rights Reserved.

7

Acetated Ringer’s solution is a slightly hypotonic infusion fluid (osmolality 270 mosmol/kg) that has inspired the belief that the fluid causes a shift of water volume to the intracellular space. In conclusion, infusion of Acetated Ringer’s solution does not promote cellular swelling as a result of the excretion of urine that is low in sodium. A slight dehydration of fluid from the intracellular space still persisted when our measurements ended 2 h after completing the infusion ⁽⁹⁾ .

Rapid Water and Slow Sodium Excretion of Acetated Ringer’s Solution Dehydrates Cells;

Robert G. Hahn, MD PhD, and Dan Drobin, MD PhD

Söder Hospital, S-118 83 Stockholm, Sweden

8

Acetated Ringer’s ** is another isotonic solution often used for replacement therapy ⁽¹⁰⁾ .

http://en.wikipedia.org/wiki/Intravenous/acetate