Use of Albumin in Children with Dengue Shock: A Prospective Interventional Study from a Tertiary Care Hospital in Southern India

1. Assistant Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. 2. Junior Resident, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. 3. Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.

Abstract

Introduction: Dengue Shock Syndrome (DSS) is a major cause of paediatric morbidity and mortality in tropical regions. While isotonic crystalloids remain first-line therapy, a subset of children remains haemodynamically unstable and requires rescue fluids. Evidence supporting albumin use in paediatric DSS is limited.

Aim: To evaluate the effectiveness and safety of 5% human albumin in children with dengue shock unresponsive to crystalloid resuscitation.

Materials and Methods: This prospective interventional study was conducted in the Paediatric Intensive Care Unit (PICU) of the Department of Paediatrics, Sree Balaji Medical College Hospital, Chennai, Tamil Nadu, India, a tertiary care teaching hospital, from June 2024 and December 2024. Children aged 1-12 years with DSS who failed to stabilise after 30 mL/kg of isotonic crystalloids and subsequently received 5% albumin were included. Clinical parameters, laboratory values, fluid requirements, adverse events, and outcomes were analysed. Statistical analysis was performed using paired t-tests and descriptive statistics.

Results: Of 357 dengue admissions, 126 (35.3%) developed DSS. Fifty-eight children received albumin (mean age 7.2±3.1 years; 55% males). Mean time to shock reversal was 4.6±1.2 hours. Four children (6.9%) required a second albumin bolus. Haematocrit decreased significantly (45.3±6.2% to 39.8±5.5%; p-value=0.003) and platelet counts improved over 48 hours (42.1±15.7×103/μL to 78.5±22.3×103/μL; p-value=0.001). Two children developed mild transient allergic reactions; no serious adverse events or mortality occurred. Mean hospital stay was 5.3±1.6 days.

Conclusion: In children with dengue shock refractory to crystalloids, albumin was effective and safe as a rescue fluid. Its use was associated with early shock reversal and favourable clinical outcomes without significant adverse effects. Larger multicentre studies are required to define its optimal role.

Albumin, Colloid, Crystalloids, Dengue fever, Fluid therapy, Hypotension