ඩෙංගු හැදු නොත් මැරෙන්න තමයි වෙන්නෙ

The exact details and recommendations are available in guidelines published by the World Health Organization and local health authorities in endemic countries.9,14 It is not the aim of this review to re-explain them. However, the principles of fluid therapy can be summarized as follows:
•Fluid must be administered orally as much as possible. Intravenous supplementation is necessary when the patient is not able to take fluids orally (severe vomiting, prostration) or is in shock.
•The rationale in fluid management is to keep enough fluid in the vascular system during the leakage phase to avoid hypovolemia and while also avoiding overloading the patient with too much fluid.
•The recommended first-line intravenous fluid is crystalloids (0.9% saline).9
•The rate of intravenous fluid administration should be at stepwise increments or decrements with at least 4–6-hourly hematocrit monitoring during the critical phase.9
•However, in situations of shock, immediate resuscitation with 20 mL/kg boluses is recommended until blood pressure is recordable.
•Some guidelines recommend the calculation of a fluid quota for the entire critical period.14 This involves calculation of the maintenance fluid requirement for 24 hours plus a 50 mL/kg (up to 50 kg) deficit correction and spreading this total amount over 48 hours. This entails the total amount of fluid (both intravenous and oral with boluses included) to be given over the 48 hours of the critical phase.
•Colloids (eg, dextran) are recommended as second-line therapy when hypotension is not responsive to boluses of intravenous crystalloids (with reference to local or World Health Organization guidance).
•A rise in hematocrit indicates further hemoconcentration due to leakage, and hence a need for more fluids. However a drop in hematocrit may be due to either convalescence (reabsorption of extravasated fluid) or internal bleeding. If the patient is still ill and in critical phase with low platelet counts, always suspect bleeding. Sometimes there may not be any overt external manifestations of bleeding. In cases of suspected bleeding, the management strategy is transfusion of fresh whole blood.
•Administration of fluids should be guided by frequent monitoring and assessment of intravascular volume status during the critical stage, and fluids should never be administered at a constant rate without monitoringThe exact details and recommendations are available in guidelines published by the World Health Organization and local health authorities in endemic countries.9,14 It is not the aim of this review to re-explain them. However, the principles of fluid therapy can be summarized as follows:
•Fluid must be administered orally as much as possible. Intravenous supplementation is necessary when the patient is not able to take fluids orally (severe vomiting, prostration) or is in shock.
•The rationale in fluid management is to keep enough fluid in the vascular system during the leakage phase to avoid hypovolemia and while also avoiding overloading the patient with too much fluid.
•The recommended first-line intravenous fluid is crystalloids (0.9% saline).9
•The rate of intravenous fluid administration should be at stepwise increments or decrements with at least 4–6-hourly hematocrit monitoring during the critical phase.9
•However, in situations of shock, immediate resuscitation with 20 mL/kg boluses is recommended until blood pressure is recordable. •Some guidelines recommend the calculation of a fluid quota for the entire critical period.14 This involves calculation of the maintenance fluid requirement for 24 hours plus a 50 mL/kg (up to 50 kg) deficit correction and spreading this total amount over 48 hours. This entails the total amount of fluid (both intravenous and oral with boluses included) to be given over the 48 hours of the critical phase.
•Colloids (eg, dextran) are recommended as second-line therapy when hypotension is not responsive to boluses of intravenous crystalloids (with reference to local or World Health Organization guidance).




•A rise in hematocrit indicates further hemoconcentration due to leakage, and hence a need for more fluids. However a drop in hematocrit may be due to either convalescence (reabsorption of extravasated fluid) or internal bleeding. If the patient is still ill and in critical phase with low platelet counts, always suspect bleeding. Sometimes there may not be any overt external manifestations of bleeding. In cases of suspected bleeding, the management strategy is transfusion of fresh whole blood. •Administration of fluids should be guided by frequent monitoring and assessment of intravascular volume status during the critical stage, and fluids should never be administered at a constant rate with

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පුළුවන් තරම් මදුරුවන්ගෙන් පරිස්සම් වෙන එක තමයි කරන්න වෙන්න