Dengue Fever with Warning Signs
Recognition of “Warning Signs” is the cornerstone of preventing progression from uncomplicated Dengue to severe, life-threatening Dengue Hemorrhagic Fever or Dengue Shock Syndrome.
1. The Warning Signs (WHO Criteria)
Presence of any of these indicates an urgent need for admission and close monitoring:
- Abdominal Pain: Severe, continuous, or tenderness on palpation.
- Persistent Vomiting: Leading to inability to maintain oral hydration.
- Clinical Fluid Accumulation: Pleural effusion, ascites.
- Mucosal Bleed: Epistaxis, gum bleeding, hematemesis, or melena.
- Lethargy/Restlessness: Significant change in mental status.
- Liver Enlargement: Hepatomegaly > 2 cm.
- Laboratory: Rapid increase in Hematocrit concurrent with rapid decrease in platelet count.
2. Management Approach
| Phase | Key Actions |
|---|---|
| Admission | Immediate hospitalization for fluid management. |
| Fluid Therapy | Start isotonic crystalloids (e.g., Normal Saline/Ringer Lactate) based on weight and hematocrit. |
| Monitoring | Monitor vital signs, urine output, and hematocrit levels every 4–6 hours. |
3. High-Yield Clinical Pearls
- Avoid NSAIDs/Aspirin: Strictly contraindicated due to the risk of exacerbating hemorrhage. Use Paracetamol for fever control.
- The “Critical Phase”: Occurs during the transition from the febrile phase to defervescence (typically days 3–6). This is when plasma leakage is most pronounced.
NEET PG Hint: Remember: The triad of Dengue Shock Syndrome is hypotension, narrow pulse pressure (<20 mmHg), and cold/clammy skin. For more high-yield protocols and free medical questions, visit mymedschool.org.