Dengue Shock Syndrome complicated by acute liver and renal failure

Abstract

Abstract
The severity classification of viral infections according to the WHO 1997 and WHO 2009 criteria are consistent across two major disease mechanisms: plasma leakage and bleeding disorders. According to the WHO (1997) criteria, dengue hemorrhagic fever patients were divided into four levels of severity. In grade I and grade II, the patient was not affected in terms of shock. In grade III and IV dengue hemorrhagic patients, plasma leaks outside the capillaries. Grade III patients have a weak pulse, narrow pulse pressure (≤ 20 mmHg), and grade IV patients have a severe shock in which pulse and pressure cannot be measured, which is also called Dengue Shock Syndrome (DSS). The WHO (2009) criteria classified dengue infections as dengue with warning signs and severe dengue. When a large volume of plasma leaks, it results in multiple systemic complications in the body of the patient. Patients with acute hepatic failure were also  associated with acute renal failure and the occurrence of this condition was also known as hepatorenal syndrome. The patients were found to have severe liver failure resulting in portal hypertension and acute oliguric renal failure. In the early stages, the kidneys functioned normally. However, there was a circulatory disorder and a decrease in blood supply to the kidneys, which eventually caused the death of the patient, if not treated promptly. At present, there is no specific therapeutic approach, including hydration, electrolyte balance, periodic monitoring of laboratory results, acidosis treatment, therapeutic plasma therapy exchange, the use of artificial or temporary hemodialysis, and renal replacement therapy, in which the physician must select the appropriate treatment for each patient, based on the clinical conditions of patients.