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Year : 2017  |  Volume : 61  |  Issue : 6  |  Page : 526  

Can fluid resuscitation be a risk factor for laryngeal oedema in severe dengue?


Department of Critical Care Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India

Date of Web Publication12-Jun-2017

Correspondence Address:
Afzal Azim
Department of Critical Care Medicine, SGPGIMS, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_350_17

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How to cite this article:
Saran S, Azim A. Can fluid resuscitation be a risk factor for laryngeal oedema in severe dengue?. Indian J Anaesth 2017;61:526

How to cite this URL:
Saran S, Azim A. Can fluid resuscitation be a risk factor for laryngeal oedema in severe dengue?. Indian J Anaesth [serial online] 2017 [cited 2019 Nov 18];61:526. Available from: http://www.ijaweb.org/text.asp?2017/61/6/526/207765



Sir,

We sincerely thank the authors for their questions. We accept that bleeding in respiratory tract can be a complication of severe dengue, but it did not occur in our illustrated case.[1] It is difficult to point to a single factor that is responsible, as the disease manifests with multi-organ involvement. We suggest fluid resuscitation as an additional risk factor which is rarely discussed in the literature on severe dengue, where there is capillary leakage and severe inflammatory response accompanied by slow resolution as compared to mild dengue.[2] We stress that intravenous fluids should be “prescribed” only in the critical phase of dengue manifested by a rise in the haematocrit rising of 10%–20% or thrombocytopenia with features of dengue shock syndrome. Daily fluid balance should be monitored after which fluids have to be restricted.[3] We suggest that fluid removal may also be required after this phase is over as described in the four phases of fluid resuscitation (rescue, optimisation, stabilisation and de-escalation) to prevent any complications of fluid overload.[4]

Acknowledgement

We sincerely acknowledge the patient for giving consent and allowing us to write this case report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Saran S, Azim A. Can fluid resuscitation be a risk factor for laryngeal oedema in severe dengue? Indian J Anaesth 2017;61:353-4.  Back to cited text no. 1
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2.
Zhao L, Huang X, Hong W, Qiu S, Wang J, Yu L, et al. Slow resolution of inflammation in severe adult dengue patients. BMC Infect Dis 2016;16:291.  Back to cited text no. 2
    
3.
Singhi S, Kissoon N, Bansal A. Dengue and dengue hemorrhagic fever: Management issues in an Intensive Care Unit. J Pediatr (Rio J) 2007;83 2 Suppl:S22-35.  Back to cited text no. 3
    
4.
Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, et al. Four phases of intravenous fluid therapy: A conceptual model. Br J Anaesth 2014;113:740-7.  Back to cited text no. 4
    




 

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