Dengue fever is quite common in certain parts of the world. And it's quite often to see transaminitis in Dengue fever as a warning sign, and it could be fatal.
Any experience of encountering severe hepatitis in Dengue Fever?
Dear Chieng, I am a Pediatrician working in a tertiary care hospital in Kolkata (Calcutta). Altered liver function or transaminitis is a bad prognostic marker in pediatric dengue. We have encountered quite a lot of patients with dengue and simultaneous transaminitis. Ischaemic hepatitis often occurs if the patient is presenting late, severely dehydrated or MODS has set in. In PICU patients with severe dengue along with high levels of AST (often needing ventillator support) we prefer to use intravenous N-acetyl cysteine (although the role is not yet established) besides the standard care.
We have another strange observation. If a patient with severe dengue has AKI (Acute Kidney Injury) that is the toughest challenge for us. Mortality is also higher in this sub group. Fortunately, very few patients with severe dengue have AKI as per our experience in Eastern India. What is your take in this matter? Do you have similar observation?
See the article attached herewith
Have a nice day
fortunately we have not seen cases of fulminating hepatitis in dengue fever
Dr. Erick MArtinez in Cuba found that when the TGO increased 500% the prognosis of the patient with dengue is fatal, very bad. (Martinez´s Book: dengue hemorragico)
Dear Aniruddha Ghosh, thanks for the sharing.
I am a gastroenterologist and hepatologist at a tertiary hospital, Malaysia. We do see quite a number of dengue patients with transaminitis, but not fulminant hepatitis/failure. We practise infusion Nac as well (even though the role is not well established yet). What do you think about ursodeoxycholic acid? Or if any other non labelled trial?
Thanks to Muhammad Javed and Jorge Luis Sarmiento as well.
Dear Chieng, I do not have any experience with ursodeoxycholic acid in dengue induce hepatic failure. Actually in India Ursodeoxycholic acid is available in oral form and the kids who has acute liver failure usually are in very unstable condition (often in ventilation support). And usually NAC works very well as per our observation if fluid and inotrope supports are adequate enough. So, you see, we have never used in such patients. What is your observation? Have you got any good results by using in similar patients? Please share your views. This is an intriguing topic.
Have a nice day
Estimate Chieng Jin Yu, I do not know how your patients with dengue come, but the primary thing is that at the primary level should be given a proper hydration to double maintenance either by oral route with oral serum or some autochthonous infusion with sodium 90 and sugar 20 grams or what little accepted in India: Via IV with Lactated Ringer or 0.9% Saline Solution Equal to double maintenance for 2 to 3 days, which is the duration of the shock and prevents multiorganic malfunction resulting from Shock by vasodilation, avoiding any complications And when the patient has neutropenia using an antibiotic such as Fortaz or Fortum (Ceftazidime) that has low hepatic toxicity, some have staphylococcal infection. As for ursodeoxycholic acid and dengue, I do not know any article, but I know its use and I even had good results to treat biliary lithiasis with hypercholesterolemia. You could give Complex B 5 mL in each liter of IV Hydrating Solution IV. To help you sincerely
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