OBJECTIVE : We report a 2 month-old infant as the youngest age reported in DHF case, with impending Dengue shock. Because infants have fragile endothelial vascular, we prevented the patient to fall into the shock phase, which is difficult to treat and cause mortality. We used albumin 5% as colloid to maintain intravascular volume and to restrict the vascular permeability for albumin is able to maintain the endothelial barrier.
CASE : A 2 month-old boy, came to our pediatric clinic with fever started in the same day and refused to suckle. The temperature was 39,9?C, and the infant was irritable; other physical examinations were normal. He was hospitalized because of low intake. On the second day, the blood test revealed haemoconcentration, platelet count was 111 x103/?L, and CRP level was 6.6. On the fourth day of illness, we heard rhonchi at both lung bases. The abdomen looked distended, hypertympanic, the circumference was 46 cm, and ultrasound examination showed ascites and bilateral pleural effusion. Heart rate was normal, capillary refill time was 3 seconds, pulse was still strong with sufficient volume, the extremities were getting cold. Be aware of upcoming shock, the patient was transferred to Pediatric High Care Unit for monitoring. We administered Ringer Lactate as the crystalloid fluid (6-7 ml/kg/hour) and Albumin 5% as the colloid fluid (10-20 ml/kg/dose) per 12 hours. After 3 times administering albumin 5%, the outcome was 4 cm abdominal circumference reduction, as daily diuresis reached 5.4-6.6 ml/kg/hour. On the seventh day, the patient was transferred back to pediatric ward, and discharged on the next day. The diagnosis was reinforced by a positive anti-Dengue IgM rapid test on the fifth day.
CONCLUSION : Albumin 5% provided a good outcome in preventing the phase of Dengue shock in infant.