From the Guidelines
Management of dengue fever focuses primarily on supportive care, with the most recent and highest quality study 1 emphasizing the importance of rest, hydration, and monitoring for warning signs of severe dengue. The management approach is based on the pathophysiology of dengue, which involves increased vascular permeability leading to plasma leakage, potential hypovolemic shock, and coagulation abnormalities.
- Patients should rest and maintain adequate hydration by drinking plenty of fluids (water, oral rehydration solutions) 1.
- Acetaminophen (paracetamol) can be taken for fever and pain at a dose of 500-1000 mg every 6 hours, not exceeding 4000 mg daily for adults 1.
- NSAIDs like ibuprofen and aspirin should be strictly avoided as they can increase bleeding risk 1.
- Close monitoring for warning signs of severe dengue is essential, including severe abdominal pain, persistent vomiting, bleeding gums, rapid breathing, fatigue, restlessness, and liver enlargement 1.
- Laboratory monitoring of complete blood count, particularly platelet counts and hematocrit levels, is important during the critical phase (days 3-7 of illness) 1.
- Severe cases require hospitalization for intravenous fluid therapy, blood transfusions if necessary, and close monitoring of vital signs and organ function 1.
- Prevention through mosquito control measures remains crucial to avoid infection and transmission 1. In terms of fluid resuscitation, crystalloids and/or colloids can be used, with colloids potentially beneficial in children with severe Dengue shock syndrome 1. Additionally, dopamine or epinephrine can be used in patients with persistent tissue hypoperfusion despite liberal fluid resuscitation 1. It is also important to measure arterial blood pressure and heart rate frequently in patients requiring dopamine or epinephrine 1. Furthermore, intravenous hydrocortisone or prednisolone can be administered to adult patients requiring escalating dosages of epinephrine or dopamine 1. Overall, the management of dengue fever requires a comprehensive approach that takes into account the patient's clinical presentation, laboratory results, and potential complications.
From the Research
Management Strategies for Dengue Fever
The management of dengue fever is primarily supportive and symptomatic, with a focus on frequent monitoring and adjusting strategies as needed 2. The key to successful management is early recognition and treatment of shock, which is a medical emergency requiring prompt and adequate fluid replacement 2, 3.
Fluid Management
- Crystalloids are the fluid of choice in initial management, given as boluses as rapidly as possible 2, 3
- Colloidal fluids, including albumin, may be indicated in patients with massive plasma leakage or those who have received large volumes of crystalloids 2, 3
- Frequent recording of vital signs and hematocrit determinations are essential in evaluating the results of treatment 2
Monitoring and Treatment
- Patients with dengue hemorrhagic fever or warning signs of dengue should receive intravenous fluid therapy 4
- Close monitoring for signs of shock, such as a rise in hematocrit of 20% along with a continuing drop in platelet count, is crucial 2
- Supportive therapy with blood products, such as blood, fresh frozen plasma, and platelet transfusions, may be necessary for patients with severe bleeding or disseminated intravascular coagulation (DIC) 2, 5
Platelet Transfusion
- Prophylactic platelet transfusion in adult dengue patients with platelet count <20,000/mm3 without bleeding may not be beneficial and may even cause harm by slowing platelet recovery and increasing hospital stay 5
Hydration and Hospital Management
- Hydration tents can be an effective way to provide early detection, treatment, and serial follow-up of patients with dengue fever, reducing the need for hospitalization 4
- Hospital management may include fluid therapy, blood component transfusion, and other modalities of treatment, such as steroids and recombinant factor VII, as well as management of complications 6