Fluid and Hemodynamic Management in Severe Dengue.

In the critical phase of dengue fever, the leakage of intravascular fluid into interstitial space and 3rd space can cause hemoconcentration and severe complications such as dengue shock syndrome (DSS), and it can lead to multiple organ failure, followed by death. Close monitoring, early detection and prompt management are the keys in successful treatment. In a hemodynamically unstable patient, crystalloid is the fluid of choice in initial management. However, if they are not responsive despite adequate resuscitation, a careful search for others causes is mandatory and fluids should be switched from crystalloid to colloid. If the leakage leads to restriction of the use of fluids (pulmonary edema), the addition of a vasopressor such as norepinephrine needs to be considered. After stabilizing the hemodynamics and clinical improvement, the physician has to know when to reduce and discontinue the fluid to avoid congestion and others complications.