Compensated Dengue Shock Syndrome (A97.2) and Obesity (E.661)

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Compensated Dengue Shock Syndrome (A97.2) and Obesity (E.661)

Nyoman Gina Henny K
1. What’s Clasiffication of DHF?
2. How is appropriate fluid management in DHF patient, especially in obesity patient?

The general principles of fluid therapy in DHF include the following:
 Isotonic crystalloid solutions should be used throughout the critical period except
in the very young infants <6 months of age in whom 0.45% sodium chloride may
be used.
 Hyper-oncotic colloid solutions (osmolarity of >300 mOsm/l) such as dextran 40
or starch solutions may be used in patients with massive plasma leakage, and those
not responding to the minimum volume of crystalloid (as recommended below).
Iso-oncotic colloid solutions such as plasma and hemaccel may not be as effective.
 A volume of about maintenance +5% dehydration should be given to maintain a
“just adequate” intravascular volume and circulation.
 The duration of intravenous fluid therapy should not exceed 24 to 48 hours for
those with shock. However, for those patients who do not have shock, the duration
of intravenous fluid therapy may have to be longer but not more than 60 to 72
hours. This is because the latter group of patients has just entered the plasma
leakage period while shock patients have experienced a longer duration of plasma
leakage before intravenous therapy is begun.
 In obese patients, the ideal body weight should be used as a guide to calculate the
fluid volume
 Rate of intravenous fluids should be adjusted to the clinical situation. The rate of
IV fluid differs in adults and children.
3. How is the result of serology test in DHF patient?
Dengue viraemia in a patient is short, typically occurs 2–3 days prior to the onset of
fever and lasts for four to seven days of illness. During this period the dengue virus,
its nucleic acid and circulating viral antigen can be detected. Antibody response to
infection comprises the appearance of different types of immunoglobulins; and IgM
and IgG immunoglobulin isotypes are of diagnostic value in dengue. IgM antibodies
are detectable by days 3–5 after the onset of illness, rise quickly by about two weeks
and decline to undetectable levels after 2–3 months. IgG antibodies are detectable at
low level by the end of the first week, increase subsequently and remain for a longer
period (for many years). Because of the late appearance of IgM antibody, i.e. after
five days of onset of fever, serological tests based on this antibody done during the
first five days of clinical illness are usually negative
4. What’s our concern, if we found patient with suspect dengue haemorrhagic fever?
If we found patient with dengue haemorrhagic fever, we must focus on signs of
plasma leakage and warning sign, so we must observe the warning sign in our patient.
5. What are factors that contribute to prognosis of DHF?

The following host factors contribute to more severe disease and its complications:
 infants and the elderly

 obesity
 peptic ulcer disease,
 women who have menstruation or abnormal vaginal bleeding,
 haemolytic diseases such as glucose-6-phosphatase dehydrogenase (G-6PD)
deficiency,
 thalassemia and other haemoglobinopathies,
 congenital heart disease,
 chronic diseases such as diabetes mellitus, hypertension, asthma, ischaemic
heart disease,
 chronic renal failure, liver cirrhosis
 patients on steroid or NSAID treatment
6. Why obesity can be determinant factor for prognosis of DHF?

In obesity there is accumulation of fat tissue due to an increase in the number and size
of adipocyte cells. Among the available fatty tissue, white fat tissue adipocytes secrete
and release TNF α (tumor necrosis factor α) pro-inflammatory cytokines and some
interleukin (IL) namely IL-1 β, IL-6, and IL- 8. In obesity there will be an increase in
TNF α and IL-6 expression, whereas in DSS, TNF α, IL-1, IL-6 and IL-8 are
produced. So, Theoretically, obesity may affect the severity of dengue infection due
to the increased production of white adipose tissue which causes increased
inflammation mediator production
Daftar Pustaka
World Health Organization (WHO) Regional Office for South-East Asia. Comprehensive
guidelines for prevention and control of dengue and dengue hemorrhagic fever. 2011.
Elmy, Arhana, IB., Suandi IKG., Sidiartha IG. Obesitas Sebagai Faktor Risiko Sindrom Syok
Dengue. Sari Pediatri 2009;11:234-43.
Mengetahui,
dr. I Wayan Gustawan, Sp.A(K)

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Resume Evidence Based Case

Compensated Dengue Shock Syndrome (A97.2) and Obesity (E.661)

1. What’s Clasiffication of DHF?

2. How is appropriate fluid management in DHF patient, especially in obesity patient?

3. How is the result of serology test in DHF patient?

5. What are factors that contribute to prognosis of DHF?

 infants and the elderly

6. Why obesity can be determinant factor for prognosis of DHF?

dr. I Wayan Gustawan, Sp.A(K)

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