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Is lactate the new panacea for endothelial dysfunction?

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    Hypertonic sodium lactate improved outcomes in children with severe Dengue, suggesting it may be a superior fluid resuscitation option. This study highlights potential benefits over Ringer's lactate for critically ill patients.

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    Area of Science:

    • Critical Care Medicine
    • Pediatric Infectious Diseases
    • Intravenous Fluid Therapy

    Background:

    • Fluid resuscitation in critically ill patients is challenging with standard crystalloids.
    • Severe Dengue infection lacks specific treatments and vaccinations.
    • Optimizing fluid management is crucial for shock resuscitation.

    Purpose of the Study:

    • To compare hypertonic sodium lactate with Ringer's lactate for fluid resuscitation in children with severe Dengue.
    • To evaluate the effects of hypertonic sodium lactate on endothelial barrier function, coagulopathy, and fluid overload.

    Main Methods:

    • A comparative study involving children with severe Dengue.
    • Administration of hypertonic sodium lactate versus World Health Organization-recommended Ringer's lactate.
    • Assessment of lactate metabolism, endothelial function, and coagulation parameters.

    Main Results:

    • Hypertonic sodium lactate demonstrated unimpaired lactate metabolism during shock.
    • Significant improvements in endothelial barrier function were observed.
    • Limited coagulopathy and avoidance of fluid overload were noted with hypertonic sodium lactate.

    Conclusions:

    • Hypertonic sodium lactate may offer advantages over Ringer's lactate in fluid resuscitation for severe Dengue in children.
    • Further research is needed to elucidate the mechanisms behind lactate's role in resuscitation and its potential benefits.