TATALAKSANA CAIRAN PADA DEMAM BERDARAH DENGUE

Maintenance

ONLY ISOTONIC INFUSION

Warm and pink extremities

Clear consc-shock can be missed Restless or lethargy

if we dont touch the patient
Capillary refill time ( >2 sec) Mottled skin, Cap refill time
Cool extremities
Cold,clammy extremities
Weak peripheral pulses

Good volume peripheral pulses

Tachycardia

Feeble or absent peripheral pulses

Normal heart rate for age

Normal pulse pressure for age

Normal syst pressure , raised

diastolic; postural hypotension
Narrowing pulse pressure

Severe tachycardia; bradycardia in

late shock
Narrowed pulse pressure(<20)

Normal respiratory rate for age

Tachypnea

Hyperpnoea/Kussmaul

Normal urine output

Reduced l urine output

Oliguria/Anuria

Clear consciousness
Brisk capillary refill time (<2 sec)

Maintenance solution:
20 drops/min or 3 ml/kg/hr

Replacement solution:
5-10 ml/kg/hr

Replacement solution:
Bolus 20 ml/kg (15 min) or colloid

www. moh.gov.my : Management of Dengue Infection in Adults.2 edition 2008.

DENGUE GUIDELINES FOR DIAGNOSIS,TREATMENT, PREVENTION AND CONTROL. New Edition 2009
Yip WCL. Dengue Haemorrhagic Fever: Current Approaches to Management.Medical Progress October 1980

Ganong WF. Cardiovascular homeostasis in health and disease. In: Review of Medical Physiology. 22nd Edition. London: McGraw-Hill;
2005:p.630-46.

COMPENSATED SHOCK

Kristaloid (Asering/RL/NS) 5 - 10 ml/kg selama 1 jam

Perbaikan

Ya

Tidak
Periksa Hematokrit (Ht)

Turunkan jadi 5-7 ml/kg/jam

untuk 1-2 jam,kmd:

WARNING SIGNS

Ht

Ht atau tinggi

Turunkan jadi 3-5 ml/kg/jam selama 2-4 jam;

Turunkan jadi 2-3 ml/kg/jam selama 2-4 jam.

Berikan bolus cairan kedua

Jika terus membaik, cairan bisa dikurangi lagi 10 - 20 ml/kg/jam selama 1 jam
Pantau hematokrit ( Ht) setiap 6-8 jam.
Jika pasien tidak stabil, lihat kadar Ht:
Jika Ht naik, beri bolus cairan atau tambah
Jika Ht turun pertimbangkan transfusi fresh
whole blood

Abdominal pain or tenderness

Persistent vomiting
Clinical fluid accumulation (pleural effusion, ascites)
Mucosal bleed
Restlessness or lethargy
Liver enlargement > 2 cm
Laboratory : Increase in HCT concurrent with rapid
decrease in platelet

Transfusi
fresh whole
blood

COMPENSATED SHOCK ISOTONIC CRYS 10 ml/kg/hr

Perbaikan
Capillary refill > 2 sec
Narrowing pulse pressure
Tachycardia
Tachypnoea
Cold extremities

Tidak

Ya

Hentikan infus setelah 48 jam

Jika membaik, turunkan menjadi
7 - 10 ml/kg/jam selama 1 -2 jam

DECOMPENSATED/
HYPOTENSIVE SHOCK
Ya

Kristaloid (Asering/RL/NS) atau koloid 20 ml/kg selama 15 menit

Usahakan periksa Ht sebelum resusitasi
Perbaikan
Tidak
Tinjau Ht pertama

Kristaloid atau koloid 10 ml/kg/jam selama 1 jam,

lalu teruskan dengan:
Kristaloid 5-7 ml/kg/jam selama 1-2 jam;
Ht atau tinggi

turunkan jadi 3-5 ml/kg/jam selama 2-4 jam;

Ht

Berikan bolus cairan kedua (koloid)

10 - 20 ml/kg/jam selama 1 jam

turunkan jadi 2-3 ml/kg/jam selama 2-4 jam.

Transfusi
fresh whole
blood

Pantau hematokrit ( Ht) setiap 6 jam.

Perbaikan

Jika pasien tidak stabil, lihat kadar Ht:

Jika Ht naik, beri bolus cairan atau tambah
Jika Ht turun pertimbangkan transfusi fresh
whole blood

Tidak

Ya

Ulang Ht kedua

Hentikan infus setelah 48 jam

Ht

Ht atau tinggi
Berikan bolus cairan ketiga (koloid)
10 - 20 ml/kg/jam selama 1 jam

Perbaikan

Ya
Referensi:
DENGUE:GUIDELINES FOR DIAGNOSIS,TREATMENT, PREVENTION AND CONTROL
New edition 2009. A joint publication of the World Health Organization (WHO) and
the Special Programme for Research and Training in Tropical Diseases (TDR)

Tidak
Ulang Ht ketiga