MANAGEMENT OF DENGUE

STEP1: OVERALL ESSESMENT STEP2:DIAGNOSIS, STAGING & SEVERITY ESSESMENT STEP3: PLAN OF MANAGEMENT

Phase of dengue illnes

Febrile
continuing high fever lasting 2-7 days facial flushing, skin erythema, myalgia, arthralgia, headache, nausea and vomiting. Mild hemorrhagic manifestations can occur. Leucopenia (WBC<5000 mm3) and mild thrombocytopenia (< 150,000 /mm3) are common in the late febrile phase presence of tender hepatomegaly favours the diagnosis of DHF Platelet count less than 100,000/mm3

 Critical
plasma leakage occurs selectively in peritoneal and pleural spaces. increase in HCT ;20% rise of HCT from the baseline is indicative of significant plasma leakage. decrease in serum albumin (<3.5 g/dl) and nonfasting serum cholesterol (<100 mg/dl). progressive organ impairment, metabolic acidosis and disseminated intravascular coagulation (DIC) which often lead to massive bleeding.

 Recovery
Improved general well being and improved appetite Appearance of convalescent rash Generalized itching (more intense in palms and soles) Hemodynamic stability Bradycardia (seen in some patients ) Diuresis Stabilization of Haematocrit (HCT may even be lower than baseline due to reabsorption of extravasated fluid) Rise in white cell count followed by a rise in the platelet count

PLAN OF MANAGEMENT 1.notify the district health office 2. carry out different management according to the group if patient

GROUP OF PATIENT
GROUP A:may be sent home
Criteria
NO warning signs Tolerate adequate oral fluids Pass urine at least once every 6 hours

Tx:
Around 2500ml oral fluid consume Physical rest Paracetamol max4g/day Avoid steroids and NSAIDs

 GROUP B : admission
Platelets count less than 100000/mm3 With warning signs Patients that who need admission without any criteria
Pregnant Old Infant Obese Co-morbid condition: kidney failure,thalassemia, DM

WARNING SIGNS
Abdominal pain Persistent of vomiting Clinical sign of plasma leakages: pleural effusion & ascites Mucosal bleeding Restlessness Liver enlargement >2cm Increase HCT, decrease platelets

 Tx
Similar to the out patients, except addition for IV Type of IV
Normal saline Hartmanns solution

How?
4mL/kg/h-1st 10kg 2ml/kg/h -2nd 10kg 1 ml/kg/h-subsequent Obese according to ideal weight

 GROUP C :require emergency treatment

organ impairment, metabolic acidosis and disseminated intravascular coagulation (DIC) Severe plasma leakage, effusion ascites etc

Tx
Fluid resuscitation Crystalloids Colloids Use in boluses of 10ml/kg/hour e.g.: dextran 40 or tetrastarch Max dextran 3 boluses/24 hour Max tetrastarch 5 boluses / 24 hour ABCS Acidosis check venous blood 8.4% sodium bicarbonate 50 ml Bleeding HCT check Calcium and other electrolyte 10% calcium gluconate 10 ml over 10 min Sugar (correct if less than 60 mg/dl) Blood transfusion Whole bloods Platelet FFP