Effectiveness of single dose intravenous methyl prednisolone in reversing on going vascular leakage in dengue

Abstract

INTRODUCTION AND OBJECTIVES: Non-resolution of vascular leakage within 48 hours in dengue shock syndrome (DSS) can result in complications in the recovery phase due to fluid overload. It can also result in death in 0.5-5%. No medication is known to reverse the ongoing vascular leakage. METHODS: Single dose intravenous methyl prednisolone (SDIVMP) was administered to 11 consecutive PCR confirmed adult patients who had ongoing high fever on the 5th day of illness and evidence of plasma leakage; significant rise in Hb, PCV, AST levels and confirmation of fluid leakage by ultrasonography. Informed written consent was obtained from all patients prior to administering SDIVMP. RESULTS: 7/11 were males. Mean age was 24 years (SD 8). At the time of administering SDIVMP; median rise of Hb 9% (5-12), PCV 12%(10-19), absolute rise of AST from 56 iu/L(24-68) to 678iu/L (320-1034) and drop in platelets from 123xl09/L (96-165) to 32xl09/L (15-56). After administration of SDIVMP in all patients, fever reduced rapidly within one hour and there was no further clinical deterioration, rise in Hb, PCV, AST or worsening of ascites or pleura! effusions. However in 5 patients platelet counts continued to drop to < 10x10 /L over the next 2-3 days. None of the patients developed sepsis, abnormal sugars or any other complications such as sepsis, or abnormalities in glucose control. CONCLUSIONS: SDIVMP was effective in reversing fluid leakage in dengue. These findings support the conduct of a double blind placebo controlled trial.