Management

&
Discussion

Nurrah Nadzirah

binti Mohd Rauzia

012014100146
PRIORITIES DURING
FIRST ENCOUNTER
– Establish whether patient has dengue
– Determine phase of illness
– Recognize warning signs and/or presence of severe
dengue
In our patient?

– Referred from KK Botanik as dengue

– Day 5 (critical phase)
– Warning signs- lethargy
PRIORITIES IN
MANAGEMENT
A Replacement of plasma losses
B Early recognition & treatment of haemorrhage
C Prevention of fluid overload
VOLUME REPLACEMENT
FOR DENGUE WITH WARNING
SIGN

– Assess airway breathing & obtain baseline HCT level

– Commence fluid resuscitation with normal saline/Ringers
lactate at 5-7ml/kg/h for 1-2h
– If hemodynamic & HCT stable, plan a gradually reducing IVF
regime
– Titrate fluid on the basis of vital signs, clinical examination,
urine output (aim for 0.5ml-1ml/kg/h), and serial HCT level.
– IVF: 5-7ml/kg/h for 2-4h then
– Reduce IVFs to 3-5ml/kg/h for 2-4h
– Reduce IVFs to 2-3ml/kg/h for 2-4 h
– Continue serial monitoring & every 6hrly HCT level
– Oral rehydration when hemodynamically stable
– Monitored fluid regime 24-48h until danger period
subside
DISCHARGE CRITERIA

– Afebrile for 24h without antipyretics

– Good appetite, clinically improve condition
– Adequate urine output
– Stable hematocrit level
– No respiratory distress
– Platelet count greater than 50, 000 cells/microliter
DISCUSSION

DENGUE

Dengue Severe dengue

Severe shock +/-

Respiratory distress
No warning sign With warning signs Severe haemorrhage
Organ failure
(CNS/Liver)