| Non-drug Therapy | |
- Recognize that the cornerstone of management of severe dengue is judicious fluid replacement.
- Use blood transfusions only in patients with significant hemorrhagic manifestations.
- Use platelet transfusions appropriately.
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Recognize that the cornerstone of management of severe dengue is judicious fluid replacement. |
- Begin appropriate fluid replacement in patients with dengue.
- Use oral rehydration in patients able to take fluids orally
- Consider intravenous fluid administration only in patients with dehydration due to severe or persistent vomiting or refusal of all food and drink
- Discontinue intravenous fluids as soon as dehydration is corrected and when oral intake is adequate
- If intravenous fluids are to be given for more than a day, limit the amount to the minimum required
- In patients with signs of plasma leakage:
- Administer intravenous fluids (Ringer's lactate or normal saline) at a rate of 7 mL/kg·h
- Once improvement is noted, gradually decrease the rate of intravenous fluids from 7 mL/kg·h to 5 mL/kg·h to 3 mL/kg·h and discontinue after 24 to 48 hours
- If patients fail to respond to treatment or their status worsens:
- Gradually increase the rate of intravenous fluids from 7 mL/kg·h to 10 mL/kg·h to 15 mL/kg·h and then change to colloid solution if the hematocrit is increasing or blood if the hematocrit decreases and bleeding is suspected
- Once improvement is noted, gradually decrease the rate of intravenous fluids to 5 mL/kg·h and then to 3 mL/kg·h and discontinue after 24 to 48 hours
- In patients with signs of circulatory compromise:
- Provide immediate, rapid volume replacement with 10 to 20 mL/kg·h of Ringer's lactate or normal saline
- If no improvement is noted, replace the crystalloid solution with colloid solution if the hematocrit is increasing or blood if the hematocrit decreases
- Once improvement is noted, gradually decrease the rate of intravenous fluids from 10 mL/kg·h to 5 mL/kg·h to 3 mL/kg·h and discontinue after 24 to 48 hours
- Consider immediate administration of a colloid solution in more severely ill patients with very narrow pulse pressures (<10 mm Hg).
- Assess for improvement by looking for stable or gradually decreasing hematocrit in conjunction with stable pulse rate and blood pressure and increasing urine output.
- Use invasive devices and procedures only when strictly necessary.
- See figure Algorithm for Intravenous Fluid Infusion in Dengue Hemorrhagic Fever.
- See figure Algorithm for Intravenous Fluid Infusion in Dengue Shock Syndrome.
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Use blood transfusions only in patients with significant hemorrhagic manifestations. |
- Determine blood grouping and cross-matching as a routine precaution in all patients in shock, particularly those with prolonged shock.
- Consider blood transfusion (10 mL/kg·h) in patients with persistent shock despite a decline in hematocrit after adequate initial crystalloidal and colloidal resuscitation.
- See table Crystalloids, Colloids, and Blood Products for the Treatment of Dengue.
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Use platelet transfusions appropriately. |
- Consider using platelet transfusions when the platelet count is <10 × 109/L; use a higher threshold count when there is significant mucocutaneous bleeding.
- Give one adult therapeutic dose of platelet concentrate when platelets are given prophylactically to increase the count by 20 × 109/L.
- Consider infusion of platelet concentrates and fresh frozen plasma in patients with disseminated intravascular coagulation complicating severe dengue.
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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.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. |
Dengue
