What to do for a dengue fever patient with high fever (hyperpyrexia) of 104 F, severe body pain, normal platelet count, and normal liver function tests (LFT) on day 1, currently taking paracetamol (acetaminophen) 6 hourly?

Management of Dengue Fever with High Fever and Severe Body Pain

For a dengue-positive patient with high fever (104°F), severe body pain, and normal laboratory parameters on day 1, continue paracetamol 500mg every 6 hours as the primary treatment, ensure adequate hydration, and monitor for warning signs of severe dengue.

First-Line Treatment for Fever and Pain

• Paracetamol (acetaminophen) at standard doses is the recommended treatment for fever and pain management in dengue fever 1
• The current regimen of paracetamol every 6 hours is appropriate, but ensure not to exceed 4g per day in adults to prevent liver damage 2
• Avoid aspirin and NSAIDs completely as they increase the risk of bleeding, which is particularly dangerous in dengue fever 1

Hydration Management

• Ensure adequate oral hydration to prevent dehydration, which is crucial in dengue management 1
• For patients who can drink, provide oral rehydration solution (ORS) to maintain hydration status 1
• Monitor for signs of dehydration such as dry mucous membranes, decreased urine output, and increased thirst 3

Monitoring Parameters

• Daily complete blood count monitoring is essential, particularly to track platelet counts and hematocrit levels 1
• Despite normal initial laboratory values, dengue can progress rapidly, so daily monitoring is crucial 4
• Patients with platelet counts that drop below 25,000/μL have 7.5 times higher odds of developing severe dengue 4

Warning Signs to Monitor

• Watch for warning signs of severe dengue including:
  • Persistent vomiting 1
  • Abdominal pain or tenderness 1
  • Mucosal bleeding (gums, nose) 1
  • Lethargy or restlessness 1
  • Rising hematocrit with falling platelet count 1

Additional Supportive Measures

• Physical cooling measures like sponging with lukewarm water can help reduce fever 1
• Ensure complete rest to aid recovery and reduce metabolic demands 1
• Position the patient comfortably to minimize pain 1

Cautions with Paracetamol Use

• While paracetamol is the recommended antipyretic, be aware that standard doses in dengue patients have been associated with transaminase elevation 5
• Monitor liver function tests if treatment continues beyond 3 days, especially if fever persists 2
• If signs of liver involvement develop, consider reducing paracetamol dosage 5

Indications for Hospitalization

• Despite current stable parameters, consider hospitalization if:
  • Warning signs develop 3
  • Platelet count drops rapidly 4
  • Patient is unable to maintain adequate oral intake 1
  • Patient has comorbidities that increase risk 3

Follow-up Recommendations

• Daily follow-up for the first 3-5 days of illness is essential, as the critical phase typically occurs around day 3-7 1
• Monitor for progression to dengue hemorrhagic fever or dengue shock syndrome 6
• Ensure patient understands warning signs that require immediate medical attention 1