00000000The fluid replacement should be the minimum volume that is sufficient to maintain effective circulation during the period of leakage (24 - 48 hours). Excessive replacement will cause respiratory distress (from massive pleural effusion and ascites), pulmonary congestion and oedema.

Type of fluid:

• Crystalloid:
  Five per cent dextrose in lactated Ringer's solution (five per cent D/RL)
  Five per cent dextrose in acetates Ringer's solution (five per cent D/RA)
  Five per cent dextrose in normal saline solution (five per cent D/NSS)
  
• Colloidal:
  Dextran 40
  Plasma
  

2.5 Management of Shock

00000000DSS is a medical emergency that requires prompt and vigorous volume replacement therapy. There are also electrolyte (sodium) and acid-base disturbances. It must be considered that there is a high potential for developing DIC and that stagnant acidaemia blood will promote and/or enhance DIC, which may lead to severe haemorrhage and/or irreversible shock.

Treatment of Dengue Shock Syndrome
Replacement of plasma loss

00000000Immediate replacement of plasma loss with isotonic salt solution (five per cent dextrose in acetated Ringer's solution or five per cent dextrose in normal saline solution) at the rate of 10 -250 ml/kg/h, or, in the case of profound shock (Grade IV), as a bolus of ten ml/kg (one to two times), should take place.

00000000 In cases of continued or profound shock (with high haematocrit values), colloidal fluid (dextran of medium molecular weight in NSS or plasma) should be given following the initial fluid at a rate of 10 -20 ml/kg/h.

00000000 Blood transfusion is indicated in cases with profound or persistent shock despite declining haematocrit values after initial fluid replacement.

00000000 When improvement is apparent, the rate of IV fluid replacement should be reduced and adjusted one to two hourly throughout the 24-hour period.

00000000 Clinical and laboratory signs of Dengue Shock Syndrome which require treatment:

00000000Cold clammy skin - loiguria,
00000000Tachycardia,
00000000Hypotension or narrowed pulse pressure (less than 20 mm Hg),
00000000Low platelet count (less than 100 000/cu.mm),
00000000Rising Haematocrit values (more than 20 per cent increases).