Management For Patients With Dengue Classification

I just finished my seminar update on intravenous fluid therapy for patients with dengue classification.  And It hurts to know that Dengue Fever nowadays is becoming more dangerous than before. If not properly managed...people spotted by this virus may die.

So, i just wanted to share to you what I have learned. It might help. 

DENGUE - Also known as Breakbone, Dandy fever and mostly used Dengue Hemorrhagic Fever is an acute infection disease that is characterized headache, severe joint pain and rashes that is caused by single stranded RNA virus of the genus flea virus transmitted by mosquitoes of the genus aedes.

WHO (World Health Organization)/ DOH (Department of Health) Consensus definition fever of 2-7 days with any 2 of the following:

• Aches/pains, nausea/vomiting, abdominal pain, leukopenia (decreased number found in the blood which places individuals at increased risk of infection)

Etiologic Agent - Dengue virus 1, 2, 3, 4 and Chikungunya virus. Cases peaks in the months of July to November and lowest during the month of February to April. It is usually affects preschool and school age (5-9yo)

Transmission and Pathophysiology - Bites of Aedes aegypti (day biting female mosquitoes that breeds in household or standing clean water). With an incubation period of 6 days to 1 week, there is an increased vascular permeability and abnormal hemostasis.

Diagnostic Test - Tourniquet test (capillary fragility test or Rumpel leads Test) a presumptive test which is positive in the presence of more the 20 petechaie within an inch square, after 5 minutes of test.

 Interpretation of Hematocrit - Changes in the hematocrit level are a useful guide to treatment. Must be interpreted together with hemodynamic status, the clinical response to fluid therapy and acid base balance. Together with unstable vital signs (particularly narrowing of the pulse pressure) indicates active plasma leakage and a need for a further bolus of fluid replacement.

CLASSIFICATION 

I. Dengue Without Warning Signs

• Group A - May be sent home

II. Dengue With Warning Signs

• Group B - Referred for in-hospital care

III. Severe Dengue

• Group C - Require emergency treatment
 

MANAGEMENT

  Recommendations for Treatment GROUP A (Patients who may be sent home)

• Should be reviewed daily with full blood count and hematocrit  until they are out of the critical period. 
• Monitoring of disease progression, defervescence (an abatement of a fever as indicated by a decrease in bodily temperature)
• Rising hematocrit (which is obviously seen on complete blood count result) with concurrent rapid fall in WBC and platelet count.
• Developing of warning signs

HOME CARE

•  Adequate bed rest,  adequate fluid intake (more than 5 glasses) 
• Milk, fruit juice (caution with diabetes patient) ORS (isotonic electrolyte solution) barley, rice water, clear soup. Plain water alone may cause electrolyte imbalance
• Take paracetamol, tepid sponge bath, look for the mosquito breeding places in and around the home and eliminate them. 
• NO STEROIDS/NSAIDS such as aspirin, mefenamic acid, voltaren tablets, suppositories

If any of these are observed, seek medical attention immediately.

•  Bleeding - Red spots or patches on the skin, bleeding from nose or gums, vomiting blood, black colored stools, heavy menstruation/ vaginal bleeding
• Frequent vomiting
• Severe abdominal pain
• Drowsiness, mental confusion or seizures
• Pale, cold or clammy hands and feet and difficulty of breathing
• 
  

 GROUP B (Referred for In-Hospital Management) and GROUP C (Requires emergency treatment) are all managed in the hospital. Both groups require intravenous fluid resuscitation with the proper fluid solutions.

 TAKE CARE OF YOUR BODY

IT''S THE ONLY PLACE

YOU HAVE TO LIVE

-Jim Rohn