Fever plus any two symptoms such as headache, body malaise, myalgia, arthralgia, retro-orbital pain, anorexia, nausea, vomiting, diarrhea, flushed skin, rash, or a positive tourniquet test, along with laboratory tests.
20 mL/kg of crystalloid or colloid solution over 15 minutes.
4 grams.
Gradually reduce the rate to 5-7 mL/kg/hr for 1-2 hours, then to 3-5 mL/kg/hr, and finally to 2-3 mL/kg/hr.
Check hematocrit; if it increases or remains high, switch to colloid solutions; if it decreases, prepare for blood transfusion.
Oral fluid intake.
TFR = Maintenance IVF + Fluids for Mild Dehydration.
50 mL/kg.
A decrease in hematocrit compared to the previous value, indicating bleeding.
At least CBC (showing leucopenia with or without thrombocytopenia) and/or dengue NS1 antigen test or dengue IgM antibody test.
Abdominal pain or tenderness, persistent vomiting, clinical signs of fluid accumulation, mucosal bleeding, lethargy, restlessness, liver enlargement, and an increase in hematocrit or decreasing platelet count.
If hematocrit decreases compared to the initial reference hematocrit (<40% in children and adult females, <45% in adult males).
5-10 mL/kg.
Patients without warning signs, able to tolerate fluids, and passing urine at least once every 6 hours.
Abdominal pain or tenderness, persistent vomiting, clinical signs of fluid accumulation, mucosal bleeding, lethargy, restlessness, liver enlargement, and laboratory increase in hematocrit or decreasing platelet count.
Viral culture isolation or PCR.
1. Severe plasma leakage, 2. Severe hemorrhage, 3. Severe organ impairment.
0.9% NaCl (saline) or Ringer’s Lactate at maintenance rate.
Lives in or travels to a dengue-endemic area with fever plus any two symptoms such as headache, body malaise, myalgia, and others, along with laboratory tests showing leucopenia.
To assess hematocrit levels and other blood parameters.
Temperature pattern, fluid intake and losses, urine output, warning signs, Hct, WBC, and platelet counts.
1-4 hourly until the patient is out of the critical phase.
Shock (DSS) or fluid accumulation with respiratory distress.
Liver (AST or ALT >1000), CNS (e.g., seizures, impaired consciousness), heart (e.g., myocarditis), and kidneys (e.g., renal failure).
Patients do not have any warning signs, can tolerate adequate volumes of oral fluids, and pass urine at least once every 6 hours.
Urine output of about 0.5 mL/kg/hr.
Immediate return to the hospital if warning signs develop and written management advice.
Viral culture isolation and PCR.
Severe plasma leakage with shock, severe bleeding, or severe organ impairment.
Continue with the same rate (2-3 mL/kg/hr) for another 2-4 hours.
Co-existing conditions like pregnancy, old age, obesity, diabetes, renal failure, and social circumstances such as living alone.
No fever for 48 hours, improvement in clinical status, increasing platelet count, and stable hematocrit without intravenous fluids.
