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