Quantum of fluids in hospitalised patients with dengue and warning signs- a pilot cross-sectional study

Background: Dengue is an endemic arboviral illness in Asia with significant morbidity and mortality. The World Health Organization (WHO) in 2009 revised the category of dengue severity into Classes A, B, and C based on the presence or absence of warning signs. The quantum of oral and intravenous fluids(IVF) in hospitalised patients with Group B(warning signs) have not been studied so far. Oral fluids in hospitalised patients and monitoring of their administration with help of patients’ relatives have not been assessed. Methods: Consecutive patients with dengue fever and warning signs were studied for 48 hours after hospitalisation. Vital signs, anthropometry, biochemical and haematological investigations, electrocardiogram were studied. Patients were asked to consume between four and five litres of fluids. Maintenance and bolus IVF were administered depending upon the presence of compensated or hypotensive shock. Intake and urinary output were monitored by the patient’s attendant. Total fluids(oral and intravenous) were divided by each anthropometric measurement-height, weight, body mass index(BMI) and body surface area(BSA). Significance of compensated and hypotensive shock, thrombocytopenia and 20% change in haematocrit, bleeding episodes and the need for transfusions, and organ impairment were considered in relation to total amount of fluids received daily. Findings: Forty-one patients were studied. All had warning signs at admission, and 37 continued to have them on Day1. Serositis and/or organ involvement-hepatitis, acute kidney injury, myositis, or cardiac dysfunction were observed in 15, and bleeding manifestations were seen in seven. Patients with obesity and hypotensive shock received significantly more fluids on Day1; taller patients and those with tachycardia, higher haematocrit and elevated creatine kinase correspondingly received more on Day2. Serositis, hepatitis, severe thrombocytopenia, bleeding, and compensated shock did not have any correlation with anthropometry-related fluid calculation. Hypotensive shock had significant correlations with fluids/BSA and fluids/weight, while laboratory parameters correlated best with fluids/BMI. Interpretation: Most adults hospitalised with dengue fever and warning signs during an epidemic seem to require >100mL/kg/day of fluids during their stay. Also, advising a similar amount of fluids at home during dengue epidemics may further reduce the need for admissions as shown in some studies. In resource-poor settings, participation of patients and their relatives in the bedside management of fluid administration may go a long way in preventing morbidity and mortality in dengue fever. Adults with dengue probably need a better anthropometric measurement to decide the quantum of fluids.