علاج حمى الضنك مع الصدمة التعويضية وضغط النبض أقل من 20 ملم زئبق

References

• Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress
• Compensated shock (systolic pressure maintained + signs of reduced perfusion) pulse pressure < 20 mmHg, HCT high
• Start isotonic crystalloid 10-15 mL/kg/h for 1 h
• Measure HCT 1 then give Ringer lactate (1st bolus) Children: 10–20 mL/kg in 15–30 min Adults: 5–10 mL/kg in 15–30 min
• IV crystalloid, reduce gradually 5–7 mL/kg/h for 1–2 h, 3–5 mL/kg/h for 2–4 h, 2–3 mL/kg/h for 2–4 h
• It is essential that the rate of IV fluid be reduced as peripheral perfusion improves; but it must be continued for a minimum duration of 24 h and discontinued by 36–48 h.
• Stop IV fluids at 24–48 h
• Improvement: BP improved, pulse pressure improved, HCT decreased, urine output improved, capillary refilling time improved, pulse rate normal