Hi all, I would like to view more inputs in fluid resuscitating these dengue pts. When and how much is the question? Any rationale ib monitiong hematocrit? Thank you.
Fluid resuscitation in dengue is complicated by vascular leak syndrome. We kw that when fluids given in the absence of signs of shock could be extremely hazardous. (FEAST Trail).current recommendations for fluid resuscitation is only during vascular leak phase evident by monitoring surrogate markers of intravascular volume depletion (static and dynamic indices, hematocrit, BUN, uric acid etc).patients in vascular leak phase would be extremely volume depleted but third spaced (pleural effusions, ascites, gut edema)
Fulids should be tailored based on multiple parameters rather than a single and static assessment. Monitoring heart rate, blood pressure, urine out put,lactate clearance, static and dynamic indices could certainly help guiding in fluid resuscitation. There is no particular crystalliods shown superior to other in this regard in any randomised study.this the fact lactated ringers, more physiological would be ideal if no hyperkalemia exists.Normal saline, on other hand, associated with normal anion gap acidosis, hypercholermia induced ATN
There is no role for fluids after the vascular leak phase when recovery phase starts ,usually after day 7 of illness with gradual to massive redistribution of third spaced extracellular fluid into intravascular compartment leading to fluid overload state and hypervolemia.so a dynamic assessment of the volume status is at most priority at this juncture to prevent iatrogenic fluid overload.
Given the adverse effects of transfusion of blood component therapy, its feasible to reserve blood product transfusions to only in the face of active bleeding
Hi all,
ReplyDeleteI would like to view more inputs in fluid resuscitating these dengue pts.
When and how much is the question?
Any rationale ib monitiong hematocrit?
Thank you.
Fluid resuscitation in dengue is complicated by vascular leak syndrome. We kw that when fluids given in the absence of signs of shock could be extremely hazardous. (FEAST Trail).current recommendations for fluid resuscitation is only during vascular leak phase evident by monitoring surrogate markers of intravascular volume depletion (static and dynamic indices, hematocrit, BUN, uric acid etc).patients in vascular leak phase would be extremely volume depleted but third spaced (pleural effusions, ascites, gut edema)
ReplyDeleteFulids should be tailored based on multiple parameters rather than a single and static assessment. Monitoring heart rate, blood pressure, urine out put,lactate clearance, static and dynamic indices could certainly help guiding in fluid resuscitation. There is no particular crystalliods shown superior to other in this regard in any randomised study.this the fact lactated ringers, more physiological would be ideal if no hyperkalemia exists.Normal saline, on other hand, associated with normal anion gap acidosis, hypercholermia induced ATN
ReplyDeleteThere is no role for fluids after the vascular leak phase when recovery phase starts ,usually after day 7 of illness with gradual to massive redistribution of third spaced extracellular fluid into intravascular compartment leading to fluid overload state and hypervolemia.so a dynamic assessment of the volume status is at most priority at this juncture to prevent iatrogenic fluid overload.
ReplyDeletewhats the role of blood and blood products especially the FFP?
ReplyDeleteGiven the adverse effects of transfusion of blood component therapy, its feasible to reserve blood product transfusions to only in the face of active bleeding
Delete