علاج حمى الضنك مع زيادة السوائل والاستسقاء والوذمة الرئوية

References

1. The most common complication is fluid overload.
2. Early signs and symptoms include puffy eyelids, distended abdomen (ascites), tachypnoea, and mild dyspnoea.
3. In the late stage of fluid overload or those with frank pulmonary oedema, furosemide may be administered if the patient has stable vital signs. If they are in shock, together with fluid overload 10 mL/kg/h of colloid (dextran) should be given. When the blood pressure is stable, usually within 10–30 min of infusion, administer IV 1 mg/kg/dose of furosemide and continue with dextran infusion until completion. IV fluid should be reduced to as low as 1 mL/kg/h until discontinuation when haematocrit decreases to baseline or below (with clinical improvement).
4. In cases with no response to furosemide (no urine obtained), repeated doses of furosemide and doubling of the dose are recommended. If oliguric renal failure is established, renal replacement therapy is to be done as soon as possible.
5. Pleural and/or abdominal tapping may be indicated and can be life-saving in cases with severe respiratory distress and failure of the above management.
6. IV fluid should be reduced to as low as 1 mL/kg/h until discontinuation when haematocrit decreases to baseline or below (with clinical improvement).