Intravenous Fluid Management in Severe Yellow Fever Requiring Hospitalization
This protocol addresses patients with severe yellow fever who have been assessed as requiring hospitalization and who need intravenous fluid treatment, in the absence of liver failure.
Clinical Scenario
Severe yellow fever is defined by the clinical judgement that hospitalization is warranted, following evaluation that includes assessment for warning signs and existing complications. This protocol applies to patients in this group who require intravenous fluid support and who do not have liver failure.
Treatment Approach
The protocol centres on intravenous resuscitation using a crystalloid solution, with fluid administration guided by structured bedside perfusion monitoring.
The full fluid selection rationale, monitoring criteria, decision thresholds, and step-by-step adaptation algorithm are in the complete protocol below.
Clinical Goal
The treatment target is improvement of perfusion. A capillary refill time exceeding 3 seconds is considered abnormal; the aim is to reach 3 seconds or less.
References
- Severe disease: those patients who clinicians assess as requiring hospitalization based on a clinical evaluation which includes assessment for the presence of warning signs and existing complications.
- WHO suggests using crystalloid fluid rather than colloid fluid in patients who require intravenous fluid treatment for suspected or confirmed severe arboviral disease.
- WHO recommends the use of capillary refill time to guide intravenous fluid management in patients with suspected or confirmed arboviral disease in addition to standard care/monitoring.
- Fluids should be given to improve targets of perfusion, at volumes and rates which may be modified based on age, weight, clinical and biological conditions (such as acid-base balance) and concomitant therapy.
- A CRT longer than 3 seconds should be considered abnormal.
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