A Comparison of Changes in Venous Lactate and Haematocrit during Fluid Resuscitation of Dengue Haemorrhagic Fever

Background Dengue haemorrhagic fever (DHF) causes significant morbidity and mortality. Judicious fluid resuscitation is the cornerstone of managing vascular leakage in DHF and haematocrit (HCT) measurement is used to monitor the response to fluid resuscitation. Serum lactate level is a measure of tissue perfusion which can be a useful parameter to monitor adequate fluid therapy. The usefulness of lactate in the management of DHF is poorly investigated. Methodology and Principal Findings A prospective observational study was conducted in two treatment centers in Sri Lanka recruiting 162 DHF patients, to study the correlation of venous lactate and HCT during fluid resuscitation. Patients were recruited within 12 hours of diagnosis of the critical phase and venous lactate level was measured at each time of performing HCT, using a pre-validated handheld lactate analyzer. Median lactate level was 1.3 (range 0.3 - 6 mmol/L) in the study population and 154 (95.2%) patients had median lactate levels less than 2 mmol/L. The HCT values in the study participants ranged from 28 to 62, with a median value of 43. There was no statistically significant correlation between the lactate and HCT values obtained at the same time. In addition, a statistically significant reduction in venous lactate was not observed following administration of fluid boluses. However, HCT reduction expected by administration of the fluid boluses was seen following dextran and crystalloid/dextran combination. Capillary HCT increased following blood transfusion. The highest lactate level measured in a patient was associated with an increase in hospital stay. Conclusions This study concludes that venous lactate is not an appropriate parameter to monitor response to fluid therapy in uncomplicated DHF.