Dengue Fever/DHF/DSS:Precautions,Prognosis,Danger Signs

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Results

DENGUE AND DENGUE HEMORRHAGIC FEVER DENGUE SHOCK SYNDROME

Dengue Fever

Related topics

Introduction

Dengue Epidemics Factors

DHF/DSS and Lab Investigations

DHF/DSS Diagnosis Laboratory criteria Complications and Tests

Dr Vishal Dublish, Dr Ira Shah

Dengue fever:

Symptomatic and supportive treatment.
Bed rest during acute febrile illness.
Avoidance of antipyretics / aspirin because of gastritis and bleeding. Paracetamol may be given.
Analgesics / mild sedation for pain.
For vomiting and sweating, oral fluids and electrolytes must be supplemented.
Monitoring of patient is required till he becomes afebrile, has normal platelet count and normal hematocrit.

DHF:
Prognosis of DHF depends on early recognition of plasma leakage by frequent estimation of hematocrit (> 20%) and platelet count.

Early volume replacement with isotonic saline reduces severity and prevents shock.
Indications of hospitalization:
- Rising hematocrit
- Platelet count < 50,000/cumm
- Hemorrhagic manifestations.
Fever - No salicylates should be given. Paracetamol is safe.
High fever, vomiting and anorexia may cause dehydration. ORS or fruit juice may be given.
Close monitoring for shock is mandatory. The critical period between transition from febrile to afebrile phase is approximately 3 days.
Serial hematocrit (or hemoglobin) should be done daily until defervescence.
Volume replacement - Volume should be replaced judiciously and rate of administration should be adjusted by serial hematocrit monitoring. Volume replaced should be minimum but sufficient to maintain effective circulation during plasma leakage. During convalescent phase resorption of extravasated plasma occurs. So if fluids are given continuously even after leakage stops, patient may develop ascitis, pleural effusion, pulmonary edema and respiratory distress.

How much to give: Maintenance fluids (Holiday-sager method) + 5-8% deficit.

Choice of fluid: 1/3 - ½ Glucose normal saline. Volume and rate of intravenous fluids should be adjusted according to volume and rate of plasma loss which can be monitored by change in hematocrit, vital parameters and urine output.
Danger signs:
- Restlessness, lethargy
- Cold extremities, circumoral cyanosis
- Reduced urine output
- Rapid and weak pulse
- Narrow pulse pressure (< 20 m Hg)
- Hypotension
- Sudden increase in hematocrit
- Progressively increasing hematocrit despite administration of intravenous fluids.
DSS: It is a medical emergency. Immediate volume replacement is essential.

Table 3: Volume replacement in Dengue Shock syndrome

To Discontinue IV fluids:

Hematocrit stabilizes ~ 40%
Improvement in appetite
Urine output - normal
Normal vital parameters.

Next : Dengue Fever Continued...

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