A Comparison of Changes in Venous Lactate and Haematocrit during Fluid Resuscitation of Dengue Haemorrhagic Fever

Abstract

AbstractBackgroundDengue haemorrhagic fever (DHF) causes significant morbidity and mortality. Judicious fluid resuscitation is the cornerstone of managing vascular leakage in DHF and haematocrit (HCT) measurement is used to monitor the response to fluid resuscitation. Serum lactate level is a measure of tissue perfusion which can be a useful parameter to monitor adequate fluid therapy. The usefulness of lactate in the management of DHF is poorly investigated.Methodology and Principal FindingsA prospective observational study was conducted in two treatment centers in Sri Lanka recruiting 162 DHF patients, to study the correlation of venous lactate and HCT during fluid resuscitation. Patients were recruited within 12 hours of diagnosis of the critical phase and venous lactate level was measured at each time of performing HCT, using a pre-validated handheld lactate analyzer. Median lactate level was 1.3 (range 0.3 - 6 mmol/L) in the study population and 154 (95.2%) patients had median lactate levels less than 2 mmol/L. The HCT values in the study participants ranged from 28 to 62, with a median value of 43. There was no statistically significant correlation between the lactate and HCT values obtained at the same time. In addition, a statistically significant reduction in venous lactate was not observed following administration of fluid boluses. However, HCT reduction expected by administration of the fluid boluses was seen following dextran and crystalloid/dextran combination. Capillary HCT increased following blood transfusion. The highest lactate level measured in a patient was associated with an increase in hospital stay.ConclusionsThis study concludes that venous lactate is not an appropriate parameter to monitor response to fluid therapy in uncomplicated DHF.Author SummaryDengue viral infection causes asymptomatic disease to severe haemorrhagic fever causing organ failure and death. Severe manifestations occur due to fluid extravasation during the critical phase of the illness and these patients with dengue haemorrhagic fever (DHF) require close monitoring and guided fluid therapy. Adequacy of fluid resuscitation is guided by capillary haematocrit (HCT) measurement. However, HCT does not reflect the tissue perfusion. Venous lactate is a reliable measure of tissue perfusion is circulatory collapse. Lactate is known to be a useful marker in identifying severe dengue disease. The usefulness of venous lactate to predict tissue perfusion during fluid resuscitation of DHF has not been performed. The present study was done to identify the usefulness of venous lactate measured by a hand-held lactate analyser in fluid resuscitation of DHF and to find the correlation of HCT and lactate values. Results revealed that uncomplicated DHF patients did not have significantly elevated lactate levels and the HCT and lactate levels performed at the same time did not correlate. Highest lactate level measured in a patient was associated with a longer hospital stay. Therefore, venous lactate is not an appropriate marker to guide fluid therapy in uncomplicated DHF.