Blood pressure drop in dengue without fluid leakage

Abstract

INTRODUCTION AND OBJECTIVES: Plasma leakage is considered the most important reason for reduction in blood pressures (BP) in Dengue shock syndrome (DSS). However other causes such as dehydration, vascular dilatation due metabolic causes such as lactic acidosls or reduced cardiac output due to myocarditis or cardiomyopathy may lead to reduction in BP. We document observations in 7 patients with dengue who had reduced BP with no evidence of fluid leakage. METHODS: We monitored 106 patients with confirmed dengue for fluid leakage with ultrasonography and other clinical, haematological and biochemical parameters. These parameters of the 7 patients (Group A) were compared with an age and sex matched group of patients from the same cohort who did not develop any complications (Group B) in order to investigate the reasons for the BP drop. RESULTS: Comparison between Group A vs Group B; systolic blood pressure drop 21.7mmHg (7.9) vs 5.7mmHg (7.9) p =0.025; diastoiic blood pressure drop 17.1mmHg (7.6) vs 7.1mmHg (7.7) p =0.03; percentage rise in Hb 2.8% (3.9) vs 5.3% (4.4) p =0.3; percentage rise of PCV 3.5% (1.5) vs 6.2% (5) ^=0.06. Five out of 7 in Group A and none in Group B had T wave inversions in the ECG in more than 3 consecutive leads. ECHO and cardiac enzymes were not done. CONCLUSIONS: Except for blood pressure drop and ECG changes, there were no significant differences in clinical, haematological or biochemical parameters between the two groups. Our findings suggest an alternative cause for the drop in blood pressure in dengue patients with no evidence of fluid leakage.