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ABSTRACT 714

COMPLICATED FLUID OVERLOAD IN DENGUE SHOCK AND ENCEPHALOPATHY OBESE CHILDREN TREATED WITH HYPERTONIC SODIUM LACTATE SOLUTION

Somasetia, D.H.1

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 161
doi: 10.1097/01.pcc.0000449440.91932.e8
Abstracts of the 7th World Congress on Pediatric Critical Care
Free

1Pediatrics, Padjadjaran University, Bandung, Indonesia

Background and aims: Severe dengue may present with encephalopathy, fluid resuscitation may lead to fluid overload. Obese children may suffer from severe fluid overload because of excessive fat, severe leakage, and mismanagement of fluid therapy.

Aims: Approved case report of severe fluid overload (>10%) after Ringer lactate fluid resuscitation in dengue shock, encephalopathy obese children, who lead to severe pleural effusion, ascites, bacterial translocation, and sepsis, treated with hypertonic sodium lactate.

Methods: A 10 years old boy referred from private hospital with dengue shock, epistaxis, combative mental status. After Ringer’s fluid resuscitation, he experienced of fluid overload, edema, pleural effusion (x-ray pleural effusion index 52.2%), and massive ascites found on ultrasonography. Laboratory examination reveal of positive antidengue IgG and IgM, very high level of ALT and AST (1624U/L and 3594 U/L), hypoglycemia, thrombocytopenia (14,000/ul), leucocytosis (19,400/ul), CRP 10 mg/L increased to 138 mg/L, hypoalbuminemia (2,73 gr/dl), lactate level 2,8 mmol/L. He treated with small volume resuscitation using hypertonic sodium lactate, 25% albumine, and furosemide. Because of prolonged fever despite negative blood culture, he received ceftriaxone (changed to meropenem 7 days later), amikacin, and metronidazole.

Results: He discharged after 18 days hospitalization (15 days in PICU and HCU) without sequele.

Conclusions: Excessive fluid overload should be avoided in dengue shock especially if obese, it may cause bacterial translocation and prolonged hospital stay. Hypertonic saline lactate has a beneficial effect for small volume resuscitation in shock and fluid overload.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies