By Andrea Hargraves 
In Sorocaba (SP), the oral serum used to hydrate patients with dengue fever is missing. The Sorocaba Department of Health reported that the oral serum is not available throughout the national market.
a BoundThe city municipal secretariat stated that in all care units, intravenous serum is applied when prescribed by doctors, and it is recommended to use homemade serum. According to the agency, it is expected that the oral moisturizing serum will be distributed in all units by the end of May.
When the report contacted the Ministry of Health of São Paulo State, it stated that “the purchase of essential inputs, such as serum, is the responsibility of municipalities” and that in February of this year, “to assist municipalities in the fight against dengue, SES expected to pay R$205 million from IGM.” SUS Paulista to 645 municipalities in the state.
“Sales growth accelerated significantly in April, much higher than expected, resulting in shortages throughout this month,” said Livar Laboratory, which produces Fexidrate oral serum. The laboratory also informed that it is working with its supplier to start May with normal stocks.
Natulab, which produces Hidraplex, said it has implemented “measures to expand our manufacturing capacity, by adding another shift to our production line. This measure is intended to meet current demand within two to three months.”
Carla Kobayashi, an infectious disease specialist at the Lebanese Syriac Hospital, realizes that “at this critical moment, we will have to choose an alternative, which is to make a homemade serum. It is better than the patient not following adequate hydration.” The infectious disease specialist explains that the oral moisturizing serum is intended for patients in groups A and B, who are undergoing treatment in outpatient clinics, without hospitalization.
According to Kobayashi, especially in the early days of dengue fever, hydration with a specific amount of fluid is recommended, which is calculated based on the patient's weight: 60 ml/kg per day. “But this total amount of fluid per day should be divided into one-third of the fluid with oral rehydration salts and the other two-thirds with other fluids,” the doctor explains.
In addition to hemoglobin and platelets, blood consists of electrolytes such as sodium, potassium, and chloride. When hydration is done with only other fluids, “the patient may not have enough electrolytes to recover. The idea of this rehydration serum is that it contains specific concentrations of these electrolytes,” says Kobayashi.
According to the infectious disease specialist, rehydration can also be done using homemade serum, “the only problem is that this measurement becomes inaccurate at home.” According to the Ministry of Health, to prepare a homemade serum, it is necessary to mix a teaspoon (like a coffee spoon) of salt and a tablespoon (like a soup spoon) of sugar in a liter of mineral water. Mix the ingredients well and serve to the patient in small spoons throughout the day.
Some warning signs of dengue fever are: severe and persistent abdominal pain, persistent vomiting, bleeding in the mucous membranes, low blood pressure, enlarged liver, lethargy or irritability, fluid accumulation in body cavities (ascites, pleural effusion, pericardial effusion). Gradual increase in hematocrit and postural hypotension (dizziness when standing).
Last article Published by the Fiocruz Center for Strategic Studies It analyzes deaths due to dengue fever and also points out that lack of assistance and lack of concern for the possible deterioration that patients may experience are the main reasons associated with deaths due to dengue fever.