Dose of Dextran in Dengue Hemorrhagic Fever

Dengue Hemorrhagic Fever (DHF) is characterized by increased vascular permeability, plasma leakage, hemoconcentration, and in severe cases, shock (Dengue Shock Syndrome – DSS).

Volume replacement is the mainstay of management. When isotonic crystalloids are insufficient, colloids like Dextran may be used as a second-line option.

Dextran in DHF:

• Preparation used: Dextran 40 (10% solution) or Dextran 70 (6% solution)
• Indication:
  • Persistent or worsening shock after initial crystalloid resuscitation
  • Severe hemoconcentration with inadequate response to crystalloids

Recommended Dose

• Initial dose:
  • 10–20 mL/kg IV over 1 hour (depending on severity of shock).
• If inadequate response:
  • May repeat with another 10–20 mL/kg over 1 hour.
• Maximum daily dose:
  • 30 mL/kg in 24 hours (to reduce risk of volume overload and adverse reactions).
• Maintenance:
  • Once the patient stabilizes, switch back to crystalloids to maintain intravascular volume.

Precautions & Monitoring

• Risk of allergic reactions, renal impairment, and coagulopathy with excessive use.
• Strict monitoring of:
  • Hematocrit (HCT)
  • Vital signs
  • Urine output
  • Signs of fluid overload (crepitations, hepatomegaly, respiratory distress)

Key Points:

Dextran should be used only in severe cases of Dengue Shock Syndrome not responsive to crystalloids, and always in a hospital setting with close monitoring. Crystalloids remain the first-line fluids.