Pocket Guideline

for
Dengue Case Management
July 2019
, DGHS, MoH&FW
 Dengue case classification by severity
Dengue warning signs Severe dengue

with 1.Severe plasma leakage

Without warning signs 2.Severe haemorrage
3.Severe organ impairment
 Dengue viral Infection
Symptomatic Asymptomatic

Mild Moderate Severe

dengue dengue dengue

DF with warning signs

DF with high risk and symptoms/
co-morbid conditions DHF Gr I & II with
minor bleeding

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A. Undifferentiated Infants A. DF with Warning A. DF with significant
DF Old Age signs and symptoms Haemorrhage
Diabetes Recurrent vomiting
B. Fever without Abdominal Pain/ B. (i) DHF with significant
Hypertension tenderness haemorrahage with or
complication like Pregnancy
bleeding. General weakness/ without shock (ii) DHF
Hypotension and CAD letharginess/ restless III & IV** DSS)
organ involvement Hemoglobinopathies Mild pleural effusion/
Immunocompromized ascites C. Severe organ involvement
Hepatomegaly (Expanded dengue
patient Syndrome)
C. Without evidence Patient on steroids, Increased Hct>20%
of capillary leakage anticoagulants or B. DHF I & II with Minor D. Severe Metabolic
immunsupperessants. bleeds Acidosis

Home Management Close Monitoring* and possibly Hospitalization Tertiary level care
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 Natural course of DHF
Day 1 2 3 4 5 6 7 8 9
Fever Shock

Pleural effusion
Ascites
Hematocrit

Plasma leakage Stop leakage Reabsorption

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IV fluid: NSS. DAR. DLR Fluid oveload
W Colloid: 10%Dextran-40
B M+5% Deficit
C (= 4,600 ml in adult)

WBC 6,000-9,000 5.000

Platelet court 200,000 100,000 50,000
Hct 35 38 45 (rising 20%)
Albumin 3.5 gm%
Cholesterol 100 gm%
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 Monitoring Chart for Dengue Patients
Instructions - Do CBC daily/bd and PCV 6 hrly. Monitor other parameters 3-4 hrly and when leaking detected monitoring every hour.
Indications to call for immediate advice
Case Refer Walk in 1. Pulse rate > 120/min with fever or > 100/min without fever.
2. Pulse Pressure 25-20 mmhg or less (in supine position)
OPD Shock Non Shock 3. Postural drop of SBP >20mmHg.
4.Significant bleeding (Haemetemesis, Malena, Bleeding PV etc.)
IPD Shock Non Shock 5. UOP <0.5ml /Kg/hr
6. CRFT >2 sec
Date Time BP Temp PR PR PP RR HCT Clinical/ Nursing INTAKE OUTPUT
(%) Lab/ Care/
Treatment Signs Blood/ IV Oral Total Urine/ Vomit Total
rate & Amount Stool /Bleed
Amount

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CBC Day of Admission BW = kgs. Height = cms Date of Fever Day of Illness
IBW = kgs. TT
Hct = WBC = Liver
Plt = Lym = Maintenance fluid = Bleeding
PMN = Epistaxis
M + 5% Deficit = Abdomen
Name Age HN AN Pulse: F = Full M= Moderate W= Weak N = Not Palpable
Ward Attending Physician
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Notes

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