[PDF][PDF] Dengue hemorrhagic fever grade III with diabetic ketoacidosis: a case report

PO Supradish, N Rienmanee, A Fuengfoo… - J Med Assoc …, 2011 - researchgate.net
PO Supradish, N Rienmanee, A Fuengfoo, S Kalayanarooj
J Med Assoc Thai, 2011researchgate.net
A 16-year-old, previously healthy Thai girl presented with DHF grade III. Fifteen hours after
the first episode of shock, she had received an excessive amount of crystalloid isotonic
solution and 20 ml per kilograms of Dextran-40 however she still had persistently rapid
pulse rate and high hematocrit but also had polyuria with more than 4 mllkglhr of urine
output. She was re-evaluated. Clinical signs showed severe dehydration with some ascites
without signs of pleural effusion. Blood gas revealed increased anion gap metabolic …
A 16-year-old, previously healthy Thai girl presented with DHF grade III. Fifteen hours after the first episode of shock, she had received an excessive amount of crystalloid isotonic solution and 20 ml per kilograms of Dextran-40 however she still had persistently rapid pulse rate and high hematocrit but also had polyuria with more than 4 mllkglhr of urine output. She was re-evaluated. Clinical signs showed severe dehydration with some ascites without signs of pleural effusion. Blood gas revealed increased anion gap metabolic acidosis. The cause of polyuria and metabolic acidosis was identified with hyperglycemia, ketouria and glucosuria. Afterwards she was diagnosed and treated as DHF grade III andDKA. Besides insulin administration, fluid resuscitation was very crucial. Intravenous fluid rehydration was needed while the unnecessary extra-volume could cause massive plasma leakage and later on fluid overload. Volume replacement was adjusted to degree of dehydration when signs of volume overload were monitored closely. She was out ofDKA at 14 hours after the start of insulin and the intravenous fluid was stopped at 27 hours (36 hours after the first episode of shock). The final diagnosis was DHF grade III, diabetes mellitus with DKA and hepatitis.
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