VOLUME REPLACEMENT IN INFANTS WITH DENGUE HEMORRHAGIC FEVER/DENGUE SHOCK SYNDROME

NGUYEN THANH HUNG Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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NGUYEN TRONG LAN Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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HUAN-YAO LEI Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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YEE-SHIN LIN Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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LE BICH LIEN Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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KAO-JEAN HUANG Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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CHIOU-FENG LIN Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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DO QUANG HA Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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VU THI QUE HUONG Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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LAM THI MY Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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TRAI-MING YEH Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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JYH-HSIUNG HUANG Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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CHING-CHUAN LIU Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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SCOTT B. HALSTEAD Department of Dengue Hemorrhagic Fever, Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; Department of Microbiology and Immunology, Department of Medical Technology, and Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Arbovirus Laboratory, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Division of Research and Diagnosis, Department of Health, Center for Disease Control, Taipei, Taiwan, Republic of China; Uniformed Services University of the Health Sciences, Bethesda, Maryland

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Volume replacement was studied prospectively in 208 infants with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). The mean volume of intravenous fluid used was 110.4 mL/kg administered over a mean period of 25.8 hours. The mean volumes of intravenous fluid replacement in infants with DSS was significantly higher than in those with non-shock DHF (129.8 mL/kg versus 102.1 mL/kg; P = 0.001). Patients with DSS had significantly higher proportional requirements for dextran and blood transfusions than non-shock infants. Recurrent shock, prolonged shock, and acute respiratory failure were recorded in 8, 6, and 13 patients, respectively. Four patients with DSS died of severe complications. Intravenous fluid replacement with special care to avoid fluid overload requires careful attention to established indications for use of colloidal solutions and blood transfusions. To improve case fatality rates, special efforts need to be directed to infants with DHF/DSS accompanied by severe complications.

Author Notes

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