The effect of Ringers acetate versus Ringers lactate on aminotransferase changes in dengue hemorrhagic fever

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ABSTRACT:  Dengue hemorrhagic fever (DHF) infection causes hepatocelullar impairment. In management of DHF, World Health Organization (WHO) recommends the crystalloids Ringer’s acetate (RA) or Ringer’s lactate (RL), which are similar in composition to plasma. Acetate in RA is not metabolized in the liver, hence not burdening the liver, whereas lactate in RL is metabolized mostly in the liver, thus placing a burden on the liver.
Objective To compare aminotransferase changes as markers of hepatocellular impairment subsequent to the use of RA and RL in the management of DHF with and without shock.
Methods This study was a double-blind randomized controlled trial on DHF patients aged 1-18 years in Cipto Mangunkusumo Hospital who had not received prior treatment with crystalloids or colloids. Subjects were randomly assigned to receive either RA or RL intravenously. Aminotransferase levels were examined on the first, second and third weeks from the onset of fever.
Results Ninety-two patients who fulfilled inclusion criteria were enrolled in this study, consisting of those without and with shock. Mean transaminase levels of patients without shock in the RA and RL groups did not differ significantly. Mean transaminase levels of patients with shock in the RA group were lower than those in the RL group, but this difference was not significant statistically. Mean alteration of transaminase levels in patients with and without shock were not significantly different.
Conclusion In DHF without shock, there is no significant difference between aminotransferase level changes of patients receiving RA and RL solutions. In DHF with shock, aminotransferase levels of patients receiving RA tend to be lower than those receiving RL, but this difference is insignificant.
Keywords: hepatocellular impairment, dengue haemorrhagic fever, Ringer’s acetate, Ringer’s lactate, aminotransferase
Author: Mulya Rahma Karyanti, MD; Hindra Irawan Satari, MD; Damayanti Rusli Sjarif, MD, PhD
Journal Code: jpkedokterangg050067

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Jp Kedokteran gg 2005