title: Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety.
abstract: BACKGROUND
  Dengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid-base status, and sodium and chloride balances, as well as in-hospital survival.
  
  
  METHODS
  A prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours).
  
  
  RESULTS
  In total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1.
  
  
  CONCLUSIONS
  Similar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00966628. Registered 26 August 2009.
authors.forename: Dadang H
authors.initials: DH
authors.lastname: Somasetia
authors.forename: Tatty E
authors.initials: TE
authors.lastname: Setiati
authors.forename: Azhali M
authors.initials: AM
authors.lastname: Sjahrodji
authors.forename: Ponpon S
authors.initials: PS
authors.lastname: Idjradinata
authors.forename: Djatnika
authors.initials: D
authors.lastname: Setiabudi
authors.forename: Hubert
authors.initials: H
authors.lastname: Roth
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
authors.forename: Eric
authors.initials: E
authors.lastname: Fontaine
authors.forename: Xavier M
authors.initials: XM
authors.lastname: Leverve
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007214:Indonesia; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation; D000077325:Ringer's Lactate; D019595:Severe Dengue / Q000628:therapy*; D016037:Single-Blind Method; D019354:Sodium Lactate / Q000627:therapeutic use*; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D019010:Vascular Cell Adhesion Molecule-1; D019354:Sodium Lactate