Background

Dengue shock syndrome (DSS) has been associated with a variety of organ failure. Dengue induced Acute Kidney Injury (DAKI) is a serious complication among children suffering from severe dengue infection. Acute Kidney Injury complicates severe dengue infection at least in 2-5% of the cases and carries a high mortality rate.

Objectives

To study the occurrence of DAKI in DSS cases presenting to a hospital.

Methods

The retrospective study to analyze DAKI using pediatric Risk, Injury, Failure, Loss of function, and End stage renal disease (pRIFLE) criteria from the data of DSS study in children aged 2 – 14 years who resuscitated with Hypertonic Sodium Lactate (HSL) and Ringer lactate (RL) from June 2008 – June 2009 in Hasan Sadikin General Hospital, Bandung, Indonesia.

Results

There were 46 subjects who receive HSL (Group I, 24 subjects) and RL (Group II, 22 subject). Using pRIFLE criteria, DAKI were found in one (Risk) and one (Injury) of 24 subjects in Group I and one (Injury) of 22 subjects in Group II. Overall, we found 3/46 (6.5%) cases of DAKI in subjects who receive early fluid resuscitation. All of subjects with DAKI were returned to normal function within 7 days. In vast majority of cases, DAKI are self limited. Using RIFLE criteria, DAKI reported in high incidence (27,1% and 35,7%) in adult.

Conclusion

Early detection of DSS and prompt fluid resuscitation may avoid DAKI. Prospective study of DAKI with large number of subjects in children is needed.

Background

The 2015 British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines recommended the following: avoiding excessive fluid resuscitation, increasing insulin infusion in persistent ketoacidosis, treating suspected cerebral oedema prior to referral and avoiding transfer unless mechanically ventilated.

Objectives

To determine:

Retrieval rates pre and post 2015 guidelines

Compliance with avoiding excessive fluid resuscitation

Compliance with treating cerebral oedema prior to referral

Compliance with increasing insulin infusion for persistent ketosis

Methods

All patients referred to our transport service (NWTs) with a diagnosis of DKA between August 2016-2018 were identified. Of 51 cases, 49 were analysed (two excluded for inadequate data).

Results

Retrieval rates have reduced from 30% (n=20/59) pre 2015 guidelines to 18% (n=9/49) post. Of the nine transferred cases, seven were transferred locally at HDU level, one was transferred by NWTs (mechanical ventilation) and one was extubated by NWTs locally.

None of the referred cases had hypotensive shock at presentation, however only 14% (n=7) received no fluid bolus. Of the remaining cases, 33% (n=16) received 10mls/kg and 53% (n=26) a >10mls/kg fluid bolus.

The commonest reason for referral was cerebral oedema – 41% (n=20), however only 50% (n=10/20) received treatment prior to referral.

Of the referred cases, 22% (n=11) showed persistently elevated ketones. All had their insulin infusions increased appropriately by the referring centre.

Conclusion

Although retrieval rates have reduced, improved compliance with BSPED guidelines for fluid resuscitation would reduce the risk of cerebral oedema. Similarly, earlier management of cerebral oedema at local centres would reduce morbidity and the need for intubation and transfer.