title: Trends of fluid requirement in dengue fever and dengue haemorrhagic fever: a single centre experience in Sri Lanka.
abstract: BACKGROUND
  Meticulous fluid management is the mainstay of treatment in dengue fever that is currently governed by consensus guidelines rather than by strong research evidence. To examine this issue we audited the fluid requirement of a cohort of adult patients with dengue fever (DF) and dengue haemorrhagic fever (DHF) in a tertiary care clinical setting.
  
  
  RESULTS
  This retrospective cohort study was conducted from July 2012 to January 2013 in Teaching Hospital, Peradeniya, Sri Lanka. Adult patients with confirmed dengue infection managed according to the national and WHO guidelines were included. Their fluid requirement was audited once data collection was over in both DF and DHF groups. Out of 302 patients, 209 (69%) had serological confirmation of dengue infection, comprising 62 (30%) patients gone into critical phase of DHF. Mean age of the DHF group was 30 years (range 12-63 years) and included more males (n = 42, 68%, p < 0.05). Their mean duration of fever on admission and total duration of fever were 4 days and 6 days respectively. DHF group had high incidence of vomiting, abdominal pain and flushing, lowest platelet counts and highest haematocrit values compared to DF group. In DHF group, the mean total daily requirements of fluid from 2(nd) to 7(th) day were 2123, 2733, 2846, 2981, 3139 and 3154 milliliters respectively to maintain a safe haematocrit value and the vital parameters. However, in DF group the fluid requirement was lowest on 3(rd) day (2158 milliliters). DHF group had significantly high fluid requirement on 5(th) -7(th) day compared to DF group (p < 0.05).
  
  
  CONCLUSIONS
  Patients in critical phase of DHF required a higher volume of fluids from the 3(rd) day of fever and again on 5(th) to 7(th) day of fever. Despite being an audit, these finding could be useful in future updates of guidelines and designing research.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. samkul@sltnet.lk.
authors.forename: Senanayake A M
authors.initials: SA
authors.lastname: Kularatne
authors.affiliation: Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. kosalagadw83@gmail.com.
authors.forename: Kosala G A D
authors.initials: KG
authors.lastname: Weerakoon
authors.affiliation: Teaching Hospital, Peradeniya, Sri Lanka. ruwanm2001@yahoo.com.
authors.forename: Ruwan
authors.initials: R
authors.lastname: Munasinghe
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.
authors.forename: Udaya K
authors.initials: UK
authors.lastname: Ralapanawa
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. manojipathi@yahoo.com.
authors.forename: Manoji
authors.initials: M
authors.lastname: Pathirage
mesh_terms: D015746:Abdominal Pain / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D001826:Body Fluids / Q000378:metabolism*; D002648:Child; D003715:Dengue / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000639:trends*; D005483:Flushing / Q000503:physiopathology; D006400:Hematocrit; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D019595:Severe Dengue / Q000503:physiopathology / Q000628:therapy*; D013188:Sri Lanka; D063128:Tertiary Health Care; D014839:Vomiting / Q000503:physiopathology