Choice of Colloidal Solutions in Dengue

Hemorrhagic Fever Patients

Siripen Kalayanarooj MD*

* WHO Collaborating Centre for Case Management of Dengue/DHF/DSS,

Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok

Background: DHF is characterized by plasma leakage and abnormal hemostasis. About 20% of DHF patients
do require colloidal solution in addition to conventional crystalloid solution for the treatment. There is only
one colloidal solution, 10% Dextran-40 in NSS that proved to be effective for this group of DHF patients.
Objective: To compare 10% dextran-40 in NSS with 10% Haes-steril in NSS in the management of DHF cases
with severe plasma leakage for their effectiveness and impact on renal function, hemostasis, disease severity,
and complications.
Material and Method: DHF patients admitted to Dengue Unit, QSNICH, who do not respond to conventional
crystalloid solution, are randomly assigned to receive either dextran or haes-steril. Clinical and laboratory
comparison are recorded and analyzed using SPSS for Window version 14.0.
Results: There are 104 DHF patients enrolled in the study; 57 are assigned in dextran and 47 in haes-steril
group. The mean ages are 8.6 + 3.9 years. About half of the patients in both groups require one dose of
colloidal solution and 25% require 2 and 3 doses (p = 0.138). The average amount of IV fluid infused in
dextran and haes-steril group are 119.4 and 129.3 ml (p = 0.227). The average drop in Hct after the bolus dose
of both colloid are 7.9 and 8.5% (p = 0.381). About 80% of the patients in each group have shock (p = 0.843).
The mean elevation of AST are 598 and 822 U (p = 0.548) while ALT elevation are 182 and 306 U (p = 0.265)
in dextran and haes-steril group, respectively. BUN and creatinine are within normal limits and are decreased
after the use of colloidal solutions. The amount of urine on day 1, 2 and 3 after the use of both colloidal
solutions are not different. Coagulogram studies (PT, PTT and TT) in both groups are not different. Patients
with significant bleeding and who require blood transfusions are 15.8 and 19.2% in dextran and haes-steril
group (p = 0.423).The incidence of fluid overload in dextran and haes-steril group are 35.1 and 40.4% (p =
0.360). Other complications are not different between dextran and haes-steril group as follows: hypocalcaemia,
hyponatremia, hypokalemia and acidosis. The overall severity and complications in both groups of patients
are much higher than in DHF patients who respond to conventional crystalloid solution. No allergic reaction
was found after the use of both colloidal solutions.
Conclusion: 10% Haes-steril is as effective as 10% dextran-40 in the treatment of DHF patients who have
severe plasma leakage. There are no differences in DHF disease severity and complications in both groups but
the disease severity and complications, especially fluid overload are observed to be more comparative with
admitted DHF patients. Both colloidal solutions are safe in DHF patients with no allergic reaction observed
and no interference in renal functions and hemostasis.

Keywords: DHF, Severe plasma leakage, Colloidal solution, Fluid overload

J Med Assoc Thai 2008; 91 (Suppl 3): S97-103

Full text. e-Journal: http://www.medassocthai.org/journal

Dengue is the most prevalent mosquito-borne dengue fever (DF) and half a million cases of dengue
viral infection worldwide. Around 100 million cases of hemorrhagic fever (DHF) are estimated to occur
annually(1,2). DHF is the most serious manifestation of
Correspondence to: Kalayanarooj S, Queen Sirikit National
dengue infection with the 2 distinct disease hallmarks
Institute of Child Health, 420/8 Rajavithi Rd, Bangkok 10400, of plasma leakage and abnormal hemostasis which
Thailand. makes it different from DF. During febrile phase, DF

J Med Assoc Thai Vol. 91 Suppl. 3 2008 S97

and DHF patients present with high continuous fever Haes-steril use in DHF patients who have indications
and non-specific signs and symptoms and we cannot fulfilled for using colloidal solution.
differentiate each other. DF patients may have more
complaints of severe headache, retro-orbital pain, Study population
muscle and bone pain. The treatment is symptomatic All DHF patients admitted to the Dengue
during this phase and no need for intravenous fluid Ward, Queen Sirikit National Institute of Child Health
administration except in a few cases with severe (QSNICH) are eligible for enrollment provided a parent
vomiting and dehydration. At the end of febrile phase, or guardian gives informed consent. The Ministry
thrombocytopenia (platelet count d < 100,000 cells/ of Public Health (MOPH), Thailand Guidelines for
cumm.) begins concomitantly with plasma leakage in Dengue Case Management 2003(7) is used for the
DHF patients while DF patients recover spontaneously management. The author, one of the DHF patients’
and uneventfully especially in children. Adult DF care team participates in the management of all study
patients may have prolonged fatigue with loss of patients. DHF disease severity is classified according
appetite for quite a period 2 weeks to 1-3 months(2-5). to the WHO classification(2). The study was performed
Most DHF cases present with minor bleeding in Dengue Unit, QSNICH, Bangkok, Thailand.
manifestations, e.g. skin bleeding, epistaxis, gum bleed-
ing, coffee-ground vomiting, hematemesis and melena. Enrollment criteria
Severe bleeding usually accompanies prolonged shock DHF patients who have received IV fluid
due to underlying diseases (peptic ulcer) or drug (5% DAR or 0.9% NSS) resuscitation/replacement
ingestion (aspirin, ibuprofen, steroid). Plasma leakage and have the following indications for using colloidal
is the main problem in most DHF cases and the solution(6-8):
management is intravenous (IV) fluid for those patients • Have signs or symptoms of fluid overload:
who cannot have adequate oral intake. Isotonic salt swollen eyelids, dyspnea, tachypnea, distended
solution, a crystalloid solution is the main choice for abdomen, positive lung signs; crepitation, rhonchi and
most DHF patients during this critical period. The total wheezing,
amount of IV fluid resuscitation and replacement • Shock and no response to conventional IV
during this critical period of 24-48 hours is limited to fluid resuscitation according to the above MOPH
maintenance about +5% deficits, since the plasma Guidelines
selectively leaked into the pleural and abdominal • Have received too much crystalloid solu-
spaces. If more fluid is given, the patients may have tion (> maintenance + 5% deficit at that point of time)
respiratory distress/failure due to massive pleural and still have high Hct or unstable vital signs
effusion and ascites(6-8).
If the patients have massive plasma leakage, Exclusion criteria
additional colloidal solution is needed in its capacity • DHF patients who have underlying diseases
to hold the plasma volume better. This colloidal solu- • No parental or guardian informed consent
tion should be in the plasma expander group, for which
its osmolarity is more than plasma, not in the plasma Clinical methods
substitute group, which is iso-osmolarity to plasma(6-8). At study entry, demographic data, history and
From our past experience, about 15-20% of admitted physical examinations are recorded.
DHF patients do need this colloidal solution(6,9,10). At
the present time, only 10% Dextran-40 in normal saline Colloidal solution
solution is used nationwide as it is easily available, The colloidal solutions used in this study are
proved to be effective and recommended in the Thai in the group of plasma expander which is effective in
Ministry of Public Health Guidelines for Dengue Case holding the intravascular volume in DHF patients:
Management 2003 and other dengue recommendation 10% Dextran-40 in normal saline solution
guidelines(6-8). (NSS) is polysaccharide which has molecular weight
of 40,000 Daltons; osmolarity 330 mosm/l; expanded
Material and Method volume is 130-300% in normal subject; half life of 6-12
Study design hours; 70% appears in urine within 24 hours.
The trial is a single-center, randomized, 10% Haes-steril in NSS is a penta-starch
single-blind comparison of 10% Dextran-40 and 10% (hydroxyethyl starch) which has average molecular

S98 J Med Assoc Thai Vol. 91 Suppl. 3 2008

weight 200,000 Daltons; osmolarity 309 mosm/l; 15 DHF grade II, 66 DHF grade III and 17 DHF grade IV
expanded volume is 140% in normal subject; half life of in both groups. The male to female ratio is 1: 1.06 and
16-24 hours; 70% appears in urine within 24 hours. the mean age is 7.8 + 3.9 years old. The majority, 90.4%
Both colloidal solutions will be given in a of DHF patients have secondary dengue infection
bolus dose, 10 ml/kg/hr at a time, interrupt with the while 5.8% have primary dengue infection. The majority
conventional IV fluid (5% Dextrose in Acetate Ringer- of cases, 53.8% are caused by Dengue 1 while 27.9, 3.8
5%DAR). Doses of colloidal solutions are repeated if and 13.5% are caused by dengue 2, 3 and 4 viruses.
there are indications. The maximum dose is 30 ml/kg/ There are no differences in the demographic data and
day with few exceptions if the patients really need the degree of severity among these 2 groups of patients
4th dose of colloidal solution(6-8). Monitoring of clinical (Table 1).
findings (at least twice a day), vital signs (at least About half of the patients receive only
every 1-2 hours), Hct (at least every 4-6 hours), and one dose, while 25% receive 2 or 3 doses of colloidal
urine output (at least every 8 hours) are done by the solution (p = 0.138). Two patients need 4 doses of
same DHF patients’ care team. colloidal solution and both are assigned in dextran
group (Table 2).
Laboratory procedures The mean Hct drops after bolus dose of both
All patients will have serologic and virologic colloidal solutions is 7.8% while in dextran and haes-
verification for dengue virus infections done by Armed steril groups are 7.5 and 8.1%, respectively (p = 0.381 ).
Forced Research Institute of Medical Sciences The mean Hct drop after the first, second, third
(AFRIMS) which is a WHO reference laboratory. and fourth doses of dextran are 8, 7.7, 5.8 and 10.5
Hct will be done before and after every dose
of colloidal solution. In addition to routine laboratory
investigation for DHF patients at QSNICH (CBC, Table 1. Demographic data
LFT and coagulogram: prothrombin time-PT, partial
thromboplastin time - PTT and thrombin time - TT), Dextran Haes-steril Total p-value
(n = 57) (n = 47) (n = 104)
BUN and creatinine are done 2 times; at the time of
enrollment, i.e. before giving the first colloidal solution Male / Female 30/27 20/27 50/54 0.204
and at discharge. Additional laboratory investigations Mean age (yr) 8.3+3.9 7.2+3.9 8.6+3.9 0.163
will be done in some patients if necessary. DHF grade I 3 3 6 0.843
DHF grade II 8 7 15
Outcome measures DHF grade III 35 31 66
The primary outcome measure is the effec- DHF grade IV 11 6 17
tiveness of the colloidal solution in the degree of DEN 1 26 20 46 0.805
reduction of Hct after each bolus dose and the total DEN 2 16 13 29
DEN 3 3 1 4
amount usage compare between both colloidal solu-
DEN 4 8 6 14
tions. The following secondary outcome measures are Not isolate 4 7 11
examined: the severity of DHF illness, the impact on Primary 4 2 6 0.071
renal function (amount of urine, BUN, creatinine) and Secondary 53 41 94
the coagulogram study (PT, PTT and TT) and other Indeterminate 0 4 4
complications especially fluid overload.

Statistical analysis
Table 2. Dose of colloid received
All analysis is using SPSS for window
version 14. Patients’ characteristic and treatment Dextran Haes-steril Total p-value
effects are compared using chi-square or Fisher’s exact (n = 57) (n = 47) (n = 104)
test for categorical variables and paired t-test or
ANOVA for continuous variables. 1 dose 30 23 53 0.138
2 doses 11 13 24
Results 3 doses 14 11 25
4 doses 2 0 2
There are 57 and 47 DHF patients enrolled in
Total 57 47 104
dextran and haes-steril group. There are 6 DHF grade I,

J Med Assoc Thai Vol. 91 Suppl. 3 2008 S99

respectively while in haes-steril group are 8.7, 7.3 and
7.4%, respectively (Fig. 1, 2).
The total IV fluid receive in dextran group
(119.4 ml/kg) is less than in haes-steril group (128.3 ml/
kg) (p = 0.227). The total IV fluid in both groups is less
in non-shock (DHF grade I & II) compared with shock
group (DHF grade III & IV) (p = 0.843) (Fig. 3). About
16% of patients in dextran group received blood
transfusions while 19.15% of patients in haes-steril
group receive transfusions (p = 0.423).
The value of BUN and creatinine are Fig. 1 Hematocrit change - dextran
decreased after using both colloidal solutions and all
values are within normal range (Table 3). The amount
of urine is observed to be more in dextran group
compared with haes-steril group in day 1 - 53.2 vs. 29.0
ml/kg (p = 0.050 ), day 2 - 45.4 vs. 30.3 ml/kg (p = 0.385)
and day 3 - 42.8 vs. 43.9 ml/kg (p = 0.917) after the first
use of colloidal solution (Table 4).
Coagulogram studies in dextran and haes-
steril group are as follows: INR > 1.3-16.4 vs. 15.2%
(p = 0.548), prolonged PTT - 38.3 vs. 54.8% (p = 0.090),
prolonged TT - 9.3 vs. 5.0 (p = 0.359) (Table 5).
Complications of fluid overload are found in
35.1 and 40.4% of patients in dextran and haes-steril Fig. 2 Hematocrit change - haes-steril
group (p = 0.360), while furosemide are given in 52.6
and 48.9% of dextran and haes-steril group (p = 0.429).
The following signs and symptoms of fluid overload
are shown in Fig. 4.

Table 3. BUN and creatinine change

Dextran Haes-steril Total p-value

(n = 57) (n = 47) (n = 104)

BUN before 17.00 15.30 14.09 0.885

BUN after 10.80 11.80 9.60 0.737
Fig. 3 Amount of IV fluid (ml/kg)
Creatinine before 0.72 0.83 0.65 0.970
Creatinine after 0.56 0.68 0.59 0.174

Table 4. Urine output

Dextran Haes-steril Total p-value

(n = 57) (n = 47) (n = 104)

Urine amount 53.2 29.0 40.0 0.050

(ml/kg) Day1
Urine amount 45.4 30.3 37.9 0.385
(ml/kg) Day2
Urine amount 42.8 43.9 43.2 0.917
(ml/kg) Day3
Fig. 4 Sign of fluid overload

S100 J Med Assoc Thai Vol. 91 Suppl. 3 2008

Table 5. Coagulogram

Dextran Haes-steril Total p-value

(n = 57) (n = 47) (n = 104)

INR (PT) abnormal (%) 16.4 15.2 15.8 0.548

PTT prolonged (%) 38.3 54.8 46.1 0.090
TT prolonged (%) 9.3 5.0 7.4 0.359
Blood transfusion (%) 15.8 19.2 17.3 0.423

Table 6. Laboratory values

Dextran Haes-steril Total p-value

(n = 57) (n = 47) (n = 104)

Mean nadir plt (cells/cumm) 40,495 43,406 41,634 0.865

Mean hemoconcentration (%) 33.2 33.9 33.7 0.733
Mean min albumin (gm%) 2.60 2.39 2.52 0.368
Mean albumin change (gm%) 1.26 1.32 1.29 0.776
Mean max AST (U) 598 822 699 0.548
Mean max ALT (U) 182 306 238 0.265
Hypocalcemia (%) 90.0 88.2 89.4 0.603
Hypocalcemia (ionized) (%) 70.0 83.3 75.0 0.344
Hyponatremia (%) 52.6 54.2 53.2 0.557
Hypokalemia (%) 23.7 12.5 19.4 0.228
Acidosis (%) 8.3 8.3 8.3 0.689
LOS 4.6 4.4 4.5 0.623

The severity of DHF as measured by platelet dextran and haes-steril cannot be used as the initial
count, percent hemoconcentration, level of serum fluid resuscitation in shock patients because of their
albumin, AST and ALT elevations and other complica- hyper-oncotic, hyper-viscosity nature. Most doctors
tions; hypocalcemia, hyponatremia, hypokalemia and misunderstand that colloidal solution is used only in
acidosis in both groups of patients are not different shock patients, but in fact the indications include those
and are shown in Table 6. DHF patients with signs of fluid overload or persistent
high Hct. In this study 79.8% of the patients have shock
Discussion while 20.2% have no shock.
Although most admitted DHF patients recover We found no renal impairment after the use of
very well with only crystalloid solution, about 10-20% both colloidal solutions. Both the average values of
have massive plasma leakage that need colloidal solu- BUN and creatinine are lower after the administration
tion(6,9,10). Previous experience revealed that iso-oncotic of both colloidal solutions. Even in 2 patients who
colloid, including plasma is not as effective as hyper- received 4 doses of dextran have normal values of
oncotic colloid(8). This is likely due to the expander BUN and creatinine. The total amount of urine on day
effect of hyper-oncotic colloid that can better hold the 1, 2 and 3 after the use of both colloidal solutions are
intravascular volume and lessen the degree of increased much more than normal amount, 38-43 ml/kg, no matter
vascular permeability in DHF, as evidence by bringing the patients have received furosemide or not.
the Hct down to about 6-10%. It’s noted that to bring The percentage of abnormal PT, PTT and TT
Hct down to this extent, both colloidal solutions have are not different between dextran and haes-steril
to be given in a bolus dose of 10 ml/kg/hr. Crystalloid group. The percentage of prolonged PT, PTT and TT
solution and iso-oncotic colloid including plasma in a are 15.8, 46.1 and 7.4% in the study group compared
bolus dose can bring Hct down to only 2-3%(8). Both with 5.2-13%, 64.1-73%and 7.6-13.3% in the previous

J Med Assoc Thai Vol. 91 Suppl. 3 2008 S101

Table 7. Disease severity compare with previous study 23-44.
2. World Health Organization. Prevention and
This study both 1995-1999 control of dengue and dengue hemorrhagic
colloid groups
fever: comprehensive guidelines. Geneva: WHO
Mean Platelet counts 41,634 53,452-63,855
Regional Publication, SEARO; 1999.
(cells.cumm) 3. World Health Organization. Dengue haemorrhagic
Mean albumin fever: diagnosis, treatment, surveillance, preven-
(mininmum) (gm%) 2.52 3.6-4.1 tion and control. 2nd ed. Geneva: WHO; 1997.
Mean AST (U) 699 192-423 4. Nimmannitya S. Dengue hemorrhagic fever:
Mean ALT (U) 238 88-159 diagnosis and management. In: Gubler DJ, Kuno
Shock (%) 79.8 44 G, editors. Dengue and dengue hemorrhagic fever.
Total IV fluid (ml/kg) 123.3 56.1-95.2 Wallingford, England: CAB International; 1997:
Blood transfusion (%) 17.3 5.3-12.9
133-45.
Fluid overload (%) 37.5 4
5. Nimmannitya S. Management of dengue and
dengue hemorrhagic fever. WHO Monograph on
Dengue/ Dengue Hemorrhagic Fever. New Delhi:
study(10). Krishnamurti et al(11) showed that 33.3 and WHO regional publication SEARO No. 22; 1993:
54.6% of DHF patients had prolonged PT and PTT 55-61.
while Srichaikul et al(12) showed the evidence of DIC in 6. Kalayanarooj S. Standardized clinical management:
58% and 82% of DHF and DSS patients in the late 70’s evidence of reduction of dengue haemorrhagic
when there were more shock cases. fever case-fatality rate in Thailand. Dengue Bull
In conclusion, DHF patients from both groups 1999; 23: 10-7.
are not different in disease severity and complications. 7. Kalayanarooj S, Nimmannitya S. Guideline in den-
Both colloidal solutions are equally effective in terms gue hemorrhagic fever case management.
of amount, dosage use and the ability to hold the plasma Nonthaburi: Ministry of Public Health, Thailand;
volume as shown by degree of reduction in Hct. There 2003.
are no serious side effects and no allergic reactions 8. Kalayanarooj S, Nimmannitya S. Dengue hemorrha-
observed for both colloidal solutions. The study gic fever case management. Bangkok: WHO
patients are more severe when compared with admitted Collaborative Centre for Case Management of
DHF patients in the previous study(10) as shown in Dengue/DHF/DSS, Queen Sirikit National Institute
Table 7: lower platelet counts, lower mean albumin, of Child Health, Bangkok Medical Publisher; 2004.
higher mean AST and ALT, more patients with shock, 9. Kalayanarooj S, Vaughn DW, Nimmannitya S,
more IV fluid and blood transfusions need and more Green S, Suntayakorn S, Kunentrasai N, et al. Early
complications of fluid overload. clinical and laboratory indicators of acute dengue
illness. J Infect Dis 1997; 176; 313-21.
Acknowledgement 10. Kalayanarooj S, Chansiriwongs V, Nimmannitya S.
The author would like to thank all the Dengue patients at the Children’s Hospital,
DHF patients’ care team of Dengue Unit, QSNICH, Bangkok: a 5-year review. Dengue Bull 2002; 26:
especially Dr. Prim Thupvong who is interested and 33-43.
helped in initiating this study; Fresenius Kabi 11. Krishnamurti C, Kalayanarooj S, Cutting MA, Peat
Thailand Ltd for supplying 10% Haes-steril in NSS for RA, Rothwell SW, Reid TJ, et al. Mechanisms of
this study. hemorrhage in dengue without circulatory collapse.
Am J Trop Med Hyg 2001; 65: 840-7.
References 12. Srichaikul T, Nimmannitya S, Artchararit N,
1. Halstead SB. Epidemiology of dengue and Siriasawakul T, Sungpeuk P. Fibrimogen metabo-
dengue hemorrhagic fever. In: Gubler DJ, Kuno G, lism and disseminated intravascular coagulation
editors. Dengue and dengue hemorrhagic fever. in dengue hemorrhagic fever. Am J Trop Med Hyg
Wallingford, England: CAB International; 1997: 1977; 26: 525-32.

S102 J Med Assoc Thai Vol. 91 Suppl. 3 2008

°“√‡≈◊Õ°„™â “√§Õ≈≈Õ¬¥å„πºŸªâ «É ¬‚√§‰¢â‡≈◊Õ¥ÕÕ°

»‘√‘‡æÁ≠ °—≈¬“≥√ÿ®

¿Ÿ ¡‘ À ≈— ß: 欓∏‘ √’√«‘∑¬“∑’ˇªìπ≈—°…≥–‡©æ“–¢Õß‚√§‰¢â‡≈◊Õ¥ÕÕ°§◊Õ°“√√—Ë«¢Õßæ≈“ ¡“·≈–§«“¡º‘¥ª°μ‘¢Õß

°“√·¢Á ß μ— « ¢Õ߇≈◊ Õ ¥ ¡’ ºŸâ ªÉ « ¬ª√–¡“≥√â Õ ¬≈– 20 ∑’Ë π Õ°®“°„™â “√ crystalloid ·≈â « μâ Õ ß„™â “√§Õ≈≈Õ¬¥å „ π
°“√√—°…“¥â«¬ ‚¥¬„π¢≥–π’È¡’‡æ’¬ß dextran-40 ‡∑à“π—Èπ∑’Ëæ‘ Ÿ®πå«à“‰¥âº≈¥’
«— μ ∂ÿ ª √– ߧå: ‡æ◊Ë Õ ‡ª√’ ¬ ∫‡∑’ ¬ ∫ª√– ‘ ∑ ∏‘ ¿ “æ¢Õß 10% dextran-40 ·≈–10% haes-steril „π°“√√— ° …“ºŸâ ªÉ « ¬
‰¢â‡≈◊Õ¥ÕÕ°∑’Ë¡’°“√√—Ë«¢Õßæ≈“ ¡“¡“° ·≈–º≈μàÕ°“√∑”ß“π¢Õß‰μ °“√·¢Áßμ—«¢Õ߇≈◊Õ¥ §«“¡√ÿπ·√ߢÕß‚√§
·≈–¿“«–·∑√°´âÕπ„πºŸâªÉ«¬
«— ¥ÿ·≈–«‘∏’°“√: ºŸâªÉ«¬‰¢â‡≈◊Õ¥ÕÕ°∑’Ë√—∫‰«â√—°…“∑’ËÀÕºŸâªÉ«¬‰¢â‡≈◊Õ¥ÕÕ° ∂“∫—π ÿ¢¿“懥Á°·Ààß™“μ‘¡À“√“™‘π’
∑’Ë ‰ ¡à μ Õ∫ πÕßμà Õ °“√√— ° …“¥â « ¬ “√§√‘ μ— ≈ ≈Õ¬¥å ® –∂Ÿ ° ÿà ¡ ‡≈◊ Õ °‡æ◊Ë Õ „Àâ ‰ ¥â √—∫ dextran À√◊ Õ haes-steril Õ“°“√
Õ“°“√· ¥ß ·≈–º≈°“√μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√®–∂Ÿ°∫—π∑÷°·≈–«‘‡§√“–À凪√’¬∫‡∑’¬∫‚¥¬„™â‚ª√·°√¡ ”‡√Á®√Ÿª SPSS
for Window version 14.0
º≈°“√»÷°…“: ¡’ºŸâªÉ«¬∑—ÈßÀ¡¥ 104 √“¬ 57 √“¬ ‰¥â√—∫ dextran ·≈– 47 √“¬ ‰¥â√—∫ haes-steril Õ“¬ÿ‡©≈’ˬ¢ÕߺŸâªÉ«¬
°≈ÿà¡ dextran ·≈– haes-steril ‡∑à“°—∫ 8.6 + 3.9 ªï ª√–¡“≥§√÷ËßÀπ÷ËߢÕߺŸâªÉ«¬∑—Èß 2 °≈ÿࡉ¥â√—∫ “√§Õ≈≈Õ¬¥å 1 §√—Èß
√âÕ¬≈– 25 ‰¥â√—∫ 2 ·≈– 3 §√—Èß (p = 0.138) ª√‘¡“≥ “√πÈ”∑—ÈßÀ¡¥∑’Ë„À⺟âªÉ«¬°≈ÿà¡ dextran ·≈– haes-steril ‡∑à“°—∫
119.4 ·≈– 129.3 ¡≈. (p = 0.227) §à“‡©≈’ˬ¢Õß Hct ∑’Ë≈¥≈߇∑à“°—∫ 7.9 ·≈– 8.5% À≈—ß°“√„Àâ dextran ·≈– haes-
steril (p = 0.381) §«“¡√ÿπ·√ߢÕß‚√§‰¡àμà“ß°—π„πºŸâªÉ«¬∑—Èß 2 °≈ÿà¡‚¥¬√âÕ¬≈– 80 ¢ÕߺŸâªÉ«¬¡’Õ“°“√™ÁÕ° (p =
0.843) §à“‡©≈’ˬ¢Õß AST ‡æ‘Ë¡¢÷Èπ„π°≈ÿà¡ dextran ·≈– haes-steril ‡∑à“°—∫ 598 ·≈– 822 U (p = 0.548) à«π ALT
‡æ‘Ë¡¢÷Èπ‡ªìπ 182 ·≈– 306 U (p = 0.265) §à“‡©≈’ˬ BUN ·≈– creatinine Õ¬Ÿà„π‡°≥±åª°μ‘„πºŸâªÉ«¬∑—Èß 2 °≈ÿà¡∑ÿ°√“¬
·≈–§à“‡©≈’ˬÀ≈—ß„Àâ “√§Õ≈≈Õ¬¥å®–πâÕ¬≈ß ª√‘¡“≥ªí “«–À≈—ß„Àâ “√§Õ≈≈Õ¬¥å¡’®”π«π¡“°·≈–‰¡àμà“ß°—π∑—Èß
2 °≈ÿà¡ Õÿ∫—μ‘°“√≥å¢Õß¿“«–πÈ”‡°‘π„π°≈ÿà¡ dextran ·≈– haes-steril ‡∑à“°—∫√âÕ¬≈– 35.1 ·≈– 40.4 (p = 0.360)
¿“«–·∑√°´âÕπÕ◊Ëπ Ê ∑’Ëæ∫„πºŸâªÉ«¬°≈ÿà¡ dextran ·≈– haes-steril ‰¡à·μ°μà“ß°—π §◊Õ hypocalcaemia, hyponatremia,
hypokalemia ·≈– acidosis §«“¡√ÿπ·√ß·≈–¿“«–·∑√°´âÕπ∑—ÈßÀ¡¥‰¡àμà“ß°—π∑—Èß 2 °≈ÿà¡ ·μà¡“°°«à“°≈ÿࡺŸâªÉ«¬
‰¢â‡≈◊Õ¥ÕÕ°∑—Ë«‰ª∑’Ë√—∫‰«â„π‚√ß欓∫“≈ ‰¡àæ∫ªØ‘°‘√‘¬“¿Ÿ¡‘·æâ„πºŸâªÉ«¬∑—Èß 2 °≈ÿà¡
√ÿª: 10% Haes-steril ¡’ª√– ‘∑∏‘¿“æ‡À¡◊Õπ°—∫ dextran „π°“√√—°…“ºŸâªÉ«¬‰¢â‡≈◊Õ¥ÕÕ°∑’Ë¡’°“√√—Ë«¢Õßæ≈“ ¡“¡“°
“√§Õ≈≈Õ¬¥å∑ßÈ— Õß™π‘¥ “¡“√∂„™â‰¥âÕ¬à“ߪ≈Õ¥¿—¬„πºŸªâ «É ¬‰¢â‡≈◊Õ¥ÕÕ° ‰¡àæ∫Õ“°“√·æâ ·≈–‰¡à¡º’ ≈μàÕ°“√∑”ß“π
¢Õ߉μ·≈–°“√·¢Áßμ—«¢Õ߇≈◊Õ¥ ºŸâªÉ«¬∑’ˉ¥â√—∫ “√§Õ≈≈Õ¬¥å∑—Èß Õß™π‘¥‰¡à¡’§«“¡·μ°μà“ß°—π„π·ßà¢Õߧ«“¡√ÿπ·√ß
¢Õß‚√§ ·≈–¿“«–·∑√°´âÕπ ·μຟ⪫¬∑—Èß 2 °≈ÿà¡π’È¡’§«“¡√ÿπ·√ߢÕß‚√§·≈–¿“«–·∑√°´âÕπ‚¥¬‡©æ“–¿“«–πÈ”‡°‘π
¡“°°«à“ºŸâªÉ«¬‰¢â‡≈◊Õ¥ÕÕ°∑—Ë«‰ª∑’Ë√—∫‰«â√—°…“„π‚√ß欓∫“≈

J Med Assoc Thai Vol. 91 Suppl. 3 2008 S103