 Dengue |
Author: Suranjith L. Seneviratne, MD, DPhil, MRCP, FRCPath; Panduka Karunanayake, MD, MRCP; Bandula Wijesiriwardena, MD, FRCP, FCCP, FCMSA, FRACP, FACP
Editorial changes - 2009-11-13
Author information and module status |
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Identify patients with dengue who require hospital admission or ICU care. |
- Hospitalize patients with suspected dengue and any of the following:
- Excessive family concern or unfeasibility of follow-up
- Extreme weakness with inability to eat or drink
- Significant dehydration requiring intravenous fluids
- Spontaneous bleeding
- Platelet counts <100 × 109/L and/or increasing hematocrit (10% to 20%)
- Clinical deterioration at the time of reduction in fever
- Severe abdominal pain or vomiting
- Admit patients with severe dengue to an ICU for:
- Evaluation and prompt treatment of manifestations of severe dengue, such as:
- Cold extremities, weak radial pulse, or prolonged capillary refill suggestive of circulatory compromise or shock
- Unconsciousness, lethargy, or combative behavior suggestive of altered sensorium
- Hematemesis, melena, or bleeding from the nose or gums
- Unusual manifestations, such as hepatic damage, cardiomyopathy, encephalopathy, and encephalitis
- Continuous hemodynamic monitoring
- Close monitoring of pulmonary, renal, and neurologic status
- Mechanical ventilation for ARDS
- Renal replacement for acute renal failure
- Be aware of the potential for a concurrent bacterial infection in patients with dengue hemorrhagic fever/dengue shock syndrome and prolonged fever (more than 5 days) and/or acute renal failure, and initiate additional antimicrobial treatment until blood culture results are negative.
- See the WHO guidelines for dengue hemorrhagic fever.
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| Bandula Wijesiriwardena, MD, FRCP, FCCP, FCMSA, FRACP, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Panduka Karunanayake, MD, MRCP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Suranjith L. Seneviratne, MD, DPhil, MRCP, FRCPath has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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