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Background Dengue shock syndrome (DSS) is characterized by severe vascular leakage and hemostasis disorder, which causes death in 1-5% of cases. World Health Organization management guidelines for fluid resuscitation in DSS remain empirical, rather than evidence-based. Objective To as sess the efficacy of ge latin compared to hydroxyethyl starch (HES) 130/0.4 solution for fluid resuscitation in children with DSS. Methods We performed a multi-centered, randomized study to compare gelatin and HES 130/0.4 solution for resuscitation of children with DSS. We randomly assigned 25 children with DSS to receive gelatin fluid and 25 children to receive HES 130/0.4. Statistical analyses were performed using Chi-square and MannWhitney tests. Results More rapid increase in pulse pressure was noted in subjects treated with HES 130/0.4 compared to those treated with gelatin at 8 hours and 28 hours of therapy (P=0.037 and P=0.048). The decrease in hematocrit in subjects treated with HES 130/0.4 was faster than that of gelatin at 4 hours of therapy (P=0.001). One patient died due to an unusual manifestation of DSS. Respiratory rate decreased faster in subjects treated with HES 130/0.4 than those treated with gelatin at 4 hours and 8 hours of therapy (P< 0.05). Body temperature remained higher in subjects treated with gelatin than HES 130/0.4 at 36 hours and 48 hours of therapy (P< 0.05). However, the decrease in platelet counts in subjects treated with HES 130/0.4 was more than that of gelatin (P=0.018). Conclusion HES 130/0.4 solution may be better for volume replacement compared to gelatin and is safe for fluid resuscitation in children with DSS.

Comparison of gelatin and HES 130/0.4 solution for fluid resuscitation in children with dengue shock syndrome