THAY ĐỔI SINH HÓA Ở TRẺ SỐT XUẤT HUYẾT DENGUE ĐƯỢC LỌC MÁU LIÊN TỤC

Abstract

Objectives: The pathogenesis of multi-organ damage in severe dengue is still unclear and may be multifactorial. In the treatment of multi-organ damage, continuous dialysis has become more well known in the past 20 years. This study characterizes biochemical changes in dengue hemorrhagic fever children undergoing continuous hemodialysis. Materials and methods: descriptive 40 children with severe dengue fever received continuous dialysis at the Intensive Care Unit - Anti-poison, Children's Hospital 1 and the Department of Infection, Children's Hospital 2 from January 1, 2017 to December 31, 2021. Results: Before dialysis: recorded 90% of patients with severe liver damage (liver enzyme values > 1000UI/l); the median value of AST was 6339,5 (2873,8 – 11155,8) UI/l and ALT was 1162,7 (614,8 – 2440,8) UI/l; 77,5% of patients progressed to liver failure; The median total and direct bilirubin was 54,8 (25,7 – 84,9) µmol/l and 30,1 (17,3 – 48,6) µmol/l, respectively; NH₃ blood recorded a median value of 116,5 (61,2 – 156,.0) µmol/l; median blood albumin was 2,4 (1,7 – 2,9) g/dl; 67,5% of patients had acute kidney injury according to pRIFLE criteria; The median creatinine concentration was 179,5 (88,5 – 244,4) mol/l, in which there were 42,5% cases of dysfunctional lesions (Failure), 17,5% cases of lesions (Injury) and 7,5% risk cases (Risk); The median blood lactate was 7,0 (3,6 – 10,5) mmol/l, of which 100% had increased blood lactate; hyponatremia is the most common, followed by hypocalcaemia and hypokalemia, the mean values of sodium, potassium, and blood calcium are 136,8 ± 7,0 mmol/l, respectively; 3,9 ± 0,7 mmol/l; 1,1 ± 0,2 mmol/l; blood gas test: average pH 7,33 ± 0,11; HCO₃^- mean 15,6 ± 5,0 mmol/l, median BE -9,8 (-14,0 - -5,5). For blood oxygenation and gas exchange, the median PaO₂/FiO₂ value was 172,2 (118,1 – 305,3), the median AaDO₂ was 390,3 (246,0 – 521,4), The average PaCO₂ is 44,0 ± 6,3. After dialysis: liver enzymes, bilirubin, blood lactate, electrolytes, pH, PaO₂/FiO₂, AaDO₂ did not change in the first 24 hours of dialysis; Blood NH₃, HCO₃^-, blood urea and blood creatinine improved at 6 and 24 hours compared with pre-dialysis. Conclusions: Most patients with severe dengue receiving dialysis have severe liver damage and kidney damage. The most common electrolyte disturbances are hyponatremia, hypokalemia, and hypocalcemia. Other biochemical changes are hypoalbuminemia, hyperbilirubinemia, hyperlactatemia, and metabolic acidosis. Tests NH₃, urea, creatinine, HCO₃- improved during the first 24 hours of continuous dialysis.