From the Research
Patients with dengue fever and warning signs in the Philippines can be discharged when they meet specific criteria, including being afebrile for at least 24-48 hours, having stable vital signs, and showing improvement in laboratory parameters such as rising platelet counts and stable hematocrit levels, as supported by the most recent study 1.
Discharge Criteria
The following criteria should be met before discharging a patient with dengue fever and warning signs:
- Afebrile (without fever) for at least 24-48 hours without the use of antipyretics
- Stable vital signs, with normal blood pressure, heart rate, and respiratory rate
- Laboratory parameters showing improvement, including:
- Rising platelet counts (typically above 50,000/mm³)
- Stable hematocrit levels
- Normal white blood cell counts
- Clinical improvement, including:
- Good oral intake
- Absence of vomiting
- Adequate urine output
- Resolution of warning signs such as abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, and increasing hematocrit with decreasing platelets
- Ambulatory and showing overall clinical improvement
Importance of Discharge Criteria
These discharge criteria are important because dengue can rapidly deteriorate during the critical phase, and ensuring these parameters have normalized indicates the patient has entered the recovery phase 2.
Pre-Discharge Instructions
Before discharge, patients should receive clear instructions about:
- Maintaining adequate oral fluid intake
- Recognizing warning signs that would necessitate immediate return to the hospital
- Scheduling follow-up appointments for continued monitoring 3. Note that the management of dengue fever with warning signs should prioritize the patient's clinical improvement and stability, as well as the prevention of complications, as highlighted in the study 4.