Treatment of Dengue Fever
The treatment of dengue fever is primarily supportive, with judicious fluid management being the cornerstone of therapy, particularly a crystalloid fluid bolus of 20 ml/kg for patients with dengue shock syndrome, followed by close monitoring and adjustment of fluid rates according to clinical response. 1
Fluid Management
Initial Assessment and Resuscitation
- For patients with dengue shock syndrome, an initial fluid bolus of 20 mL/kg is recommended 2, 1
- Fluid administration rate should be 5-10 ml/kg/hour after initial bolus, adjusted according to clinical response 1
- Vital signs should be monitored every 15-30 minutes during rapid fluid administration 1
- In profound shock, fluid bolus may need to be repeated 2-3 times 1
Monitoring for Fluid Management
- Document accurate weight
- Assess vital signs including pulse pressure
- Check baseline hematocrit
- Measure urine output
- Assess respiratory status 1
Warning Signs of Fluid Overload
- Increasing respiratory rate with normal or falling hematocrit
- Development of new crackles on lung examination
- Rising JVP
- New onset hepatomegaly
- Peripheral edema 1
If fluid overload signs develop, reduce or stop intravenous fluids if the patient is hemodynamically stable.
Patient Monitoring
Warning Signs Requiring Close Observation
- Abdominal pain or tenderness
- Persistent vomiting
- Clinical fluid accumulation
- Mucosal bleeding
- Lethargy or restlessness
- Liver enlargement
- Increasing hematocrit with rapid decrease in platelet count 1
Laboratory Monitoring
- Serial hematocrit determinations
- Platelet count monitoring
- Liver function tests (elevated liver enzymes may occur) 1
Medication Management
- Avoid aspirin and NSAIDs due to increased risk of bleeding complications 1, 3
- Use acetaminophen for fever and pain relief 1
- No specific antiviral treatment is currently recommended for routine use 4, 5
- Oxygen administration for all shock patients 1
Special Populations
Children
- Require closer monitoring
- More susceptible to fluid overload
- Regular reassessment is critical to detect deterioration early 1
Pregnant Women
- Higher risk of complications
- Require more intensive surveillance 1
Older Adults
- Higher risk of developing severe dengue due to comorbidities
- May require more aggressive management 1
Management Based on Disease Severity
Mild Dengue (without warning signs)
Dengue with Warning Signs
- Hospital admission
- Intravenous fluid therapy
- Close monitoring of vital signs, hematocrit, and urine output 1
Severe Dengue
- Intensive care management
- Aggressive fluid resuscitation
- Blood product transfusion for significant bleeding
- Organ support as needed 1, 4
Discharge Criteria
Patients can be discharged when they have:
- No fever for 48 hours without antipyretics
- Improving clinical status
- Increasing platelet count
- Stable hematocrit
- No respiratory distress
- Good urine output 1
Prevention of Transmission
- Protect patients from further mosquito exposure to prevent transmission 1
- Use mosquito nets, repellents, and appropriate clothing 3
Clinical Pitfalls to Avoid
- Overhydration: Can lead to pulmonary edema, especially in children and the elderly
- Underhydration: May result in prolonged shock and organ damage
- Delayed recognition of warning signs: Can lead to progression to severe disease
- Inappropriate use of NSAIDs: Increases bleeding risk
- Prophylactic platelet transfusion: Not recommended without active bleeding 4
Remember that dengue typically follows a triphasic course (febrile phase, critical phase, recovery phase), and management should be tailored to each phase, with the critical phase requiring the most intensive monitoring and intervention 6.