Dengue Fever with Fluid Overload: Puffy Eyelids, Ascites, and Progression to Respiratory Distress

Fluid overload is the most common complication of dengue fever. This protocol addresses patients presenting with early and progressive signs of overload — from periorbital puffiness and ascites through to dyspnoea and pulmonary oedema — where prompt changes to intravenous fluid management are required.

Clinical Scenario

This protocol applies to dengue patients who develop signs of fluid overload, which may include:

Management Approach

Management centres on an immediate adjustment of the intravenous fluid strategy: specific fluid types in current use are discontinued, and in the early stage of overload the approach transitions to a different class of bolus volume-replacement solution — with particular agents, volume ceilings, and clinical decision points that vary with the stage of presentation.

Full agent selection, dosing limits, and the complete clinical algorithm are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

The most common complication is fluid overload
Early signs and symptoms include puffy eyelids, distended abdomen (ascites), tachypnoea, and mild dyspnoea
All hypotonic solutions should be stopped
In the early stage of fluid overload, switch from crystalloid to colloid solutions as bolus fluids. Dextran 40 is effective as 10 mL/kg bolus infusions, but the dose is restricted to 30 mL/kg/day because of its renal effects.
Voluven may be effective (osmolarity = 308 moSmol) and the upper limit is 50 mL/kg/day.

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