Professional Documents
Culture Documents
KEY MESSAGES
• Look out for warning signs which may indicate severe dengue or high
possibility of rapid progression or shock.
2
MANAGEMENT OF DENGUE INFECTION IN ADULTS (2nd Edition) QUICK REFERENCE FOR HEALTH CARE PROVIDERS
DISEASE NOTIFICATION
All suspected dengue cases* must be notified by telephone to
the nearest health office within 24 hours of diagnosis, followed
by written notification within one week using the standard
notification form.
WA R N I N G S I G N S
•• Abdominal
Abdominal pain
pain
or or
tenderness
tenderness
•• P ersistent
Persistentvomiting
vomiting
•• C linical
Clinical
fluid
fluid
accumulation
accumulation(pleural
(pleural effusion/ascites)
effusion/ascites)
•• M ucosal
Mucosal bleed
bleed
•• R estlessness
Restlessness or or
lethargy
lethargy
•• Liver
Liver
enlargement
enlargement >2>2 cmcm
•• L aboratory
Laboratory : Increase
: Increase
in HCT
in concurrent
HCT concurrent
with rapid
with
rapid in
decrease decrease
plateletin platelet
LABORATORY INTERPRETATION
• In the absence of baseline HCT, a HCT value of >40% in adult
female and >46% in adult male should raise the suspicion of
plasma leakage.
3
Table 1:
STEPWISE APPROACH IN OUT PATIENT MANAGEMENT
Step 1: Overall assessment
1. History
• Date of onset of fever/illness
• Oral intake
• Assess for warning signs
• Diarrhoea
• Bleeding
• Change in mental state/seizure/dizziness
• Urine output (frequency, volume and time of last voiding)
• Pregnancy or other comorbidities
2. Physical examination
Refer to clinical parameters for disease monitoring (Table 3)
3. Investigations
i. FBC and dengue serology should be taken (as soon as possible)
ii. If no facility for HCT, refer patient to the nearest hospital
4
Table 2:
WHEN TO REFEr FOR ADMISSION
1. Symptoms:
• Warning signs
• Bleeding manifestations
• Inability to tolerate oral fluids
• Reduced urine output
• Seizure
2. Signs:
• Dehydration
• Shock
• Bleeding
• Any organ failure
3. Special Situations:
• Patients with co-morbidity e.g. diabetes, hypertension,
ischaemic heart disease, morbid obesity, renal failure,
chronic liver disease
• Elderly (>65 years old)
• Pregnancy
• Social factors that limit follow-up e.g. living far from health
facility, patient living alone
4. Laboratory Criteria:
• Rising HCT accompanied by reducing platelet count
Table 3:
DISEASE MONITORING FOR DIFFERENT PHASES OF
DENGUE ILLNESS
Frequency of monitoring
Parameter for monitoring Febrile Recovery
Critical phase
phase phase
Clinical Parameters
General well being
Daily or more Daily
Appetite/oral intake At least twice a day
frequently or more
Warning signs and more frequently
towards late frequently
Symptoms of bleeding as indicated
febrile phase as indicated
Neurological/mental state
Haemodynamic status
• Pink/cyanosis
2-4 hourly
• Extremities (cold/warm)
depending on
• Capillary refill time
4-6 hourly clinical status
• Pulse volume
• Pulse rate depending
4-6 hourly
• Blood pressure on clinical In shock-
• Pulse pressure status Every 15-30 minutes
Respiratory status till stable then 1-2
• Respiratory rate hourly
• SpO2
Daily or more Daily
Signs of bleeding, At least twice a day
frequently or more
abdominal tenderness, and more frequently
towards late frequently
ascites and pleural effusion as indicated
febrile phase as indicated
2-4 hourly
Urine output 4 hourly In shock- 4-6 hourly
Hourly
Laboratory Parameters
4-12 hourly
depending on
clinical status
Daily or more
In shock-
FBC frequently if Daily
Repeat before and
indicated
after each attempt
of fluid resuscitation
and as indicated
6
MANAGEMENT OF DENGUE INFECTION IN ADULTS (2nd Edition) QUICK REFERENCE FOR HEALTH CARE PROVIDERS
FLUID MANAGEMENT
Non-shock patient
• Encourage adequate oral intake
• Intravenous fluids are indicated in patients who are vomiting, unable to
tolerate oral fluids or an increasing HCT despite increasing oral intake.
• Crystalloid is the fluid of choice.
MANAGEMENT OF BLEEDING
• Patients with mild bleeding from the gums, per vagina, epistaxis or
petechiae do not require blood transfusion.
• Blood transfusion with whole blood or packed cell (as fresh as is
available, preferably less than 1 week old).
• If bleeding continues then consider the use of blood components.
Invasive procedures
• Endoscopy in upper GIT haemorrhage should be avoided.
• Intercostal drainage for pleural effusion is not indicated.