What is the management approach for Dengue Fever in an In-Patient Department (IPD) setting?

From the Guidelines

The management of Dengue Fever in an IPD setting should prioritize fluid resuscitation with crystalloids, such as normal saline or Ringer's lactate, as the first-line treatment, with colloids considered in cases of severe Dengue shock syndrome, as recommended by the 2012 study on sepsis management in resource-limited settings 1.

Key Management Strategies

• Fluid resuscitation: Use crystalloids as the primary fluid for resuscitation, with colloids considered for children with severe Dengue shock syndrome, characterized by a pulse pressure of less than 10 mmHg 1.
• Monitoring: Frequently monitor vital signs, including blood pressure, pulse, respiratory rate, temperature, and urine output, every 1-2 hours during the critical phase.
• Vasopressor support: Consider using dopamine or epinephrine in patients with persistent tissue hypoperfusion despite adequate fluid resuscitation, with careful monitoring of arterial blood pressure and heart rate 1.
• Corticosteroids: Administer intravenous hydrocortisone or prednisolone to adult patients requiring escalating dosages of epinephrine or dopamine, with equivalent doses considered for children with severe shock 1.

Additional Considerations

• Antipyretics: Use acetaminophen (paracetamol) for fever management, avoiding NSAIDs like ibuprofen and aspirin due to bleeding risk.
• Blood product transfusion: Transfuse platelets if the count is less than 10,000/mm³ or with active bleeding, and consider packed red blood cells for severe hemorrhage.
• Warning signs: Monitor for severe abdominal pain, persistent vomiting, mucosal bleeding, lethargy, liver enlargement, and increasing hematocrit with decreasing platelets, which may indicate severe dengue.

From the Research

Management Approach for Dengue Fever in IPD

The management of Dengue Fever in an In-Patient Department (IPD) setting involves a supportive approach, as there are no definitive curative medications available 2. The key aspects of management include:

• Judicious fluid resuscitation during the critical phase of dengue, with crystalloids being the initial fluid of choice 2, 3
• Monitoring for organ involvement in severe dengue and managing it appropriately 2
• Avoiding prophylactic platelet transfusion 2

Fluid Management

Fluid management is crucial in the treatment of Dengue Fever, particularly in patients with severe dengue or dengue shock syndrome (DSS) 4, 3, 5. The following points are important to consider:

• Crystalloid solutions, such as normal 0.9% saline or Ringer's lactate, are commonly used for plasma volume support 4
• Colloid solutions may be administered in severe cases, but they carry a greater risk of adverse events 4, 5
• The fluid requirement for adult dengue hemorrhagic fever patients during the critical phase of the illness is approximately 5279.7 ml over 48 hours, with the highest fluid requirement seen within the first 12 and 24 hours 3

Symptomatic Treatment

Symptomatic treatment of dengue fever includes managing pain and fever, and the use of nonsteroidal anti-inflammatory agents (NSAIDs) has been a topic of debate 6. The following points are important to consider:

• Consensus guidelines recommend acetaminophen to manage pain and fever, but contraindicate NSAIDs due to potentially increased bleeding risk 6
• However, epidemiologic and cohort studies suggest that NSAIDs, particularly ibuprofen, may not significantly increase bleeding risk in dengue patients 6
• Ibuprofen at over-the-counter doses may be associated with zero to minimally increased risk for postoperative bleeding events, and may provide equivalent or superior analgesic and antipyretic activity compared with acetaminophen 6