Management of Normal Dengue Fever

Symptomatic management is the cornerstone of treatment for normal dengue fever, as there is no specific antiviral therapy currently approved. 1

Initial Assessment and Monitoring

Daily complete blood count monitoring is essential, particularly to track platelet counts and hematocrit levels 1
Monitor for warning signs of progression to severe dengue, including:
- High hematocrit with rapidly falling platelet count
- Severe abdominal pain
- Persistent vomiting
- Lethargy or restlessness
- Mucosal bleeding 1, 2
Be vigilant during the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1

Acetaminophen (paracetamol) at standard doses (10-15 mg/kg every 4-6 hours, not exceeding 4 g/day in adults) is recommended for pain relief 3
Monitor liver function tests when using acetaminophen, particularly in patients with pre-existing liver disease or signs of hepatic involvement 3
Avoid aspirin and NSAIDs under all circumstances due to increased bleeding risk 3, 1, 4

Oral rehydration is appropriate for patients without signs of shock 1
Consider using a fluid chart to track intake - studies suggest this simple tool may help reduce hospitalization and need for IV fluids 5
Recommended oral fluid intake is at least five glasses or more for adults with suspected dengue fever 5
For patients showing signs of dehydration, oral rehydration solution (ORS) should be given 3
Avoid routine use of bolus intravenous fluids in patients who are not in shock 1

Development of any warning signs (persistent vomiting, abdominal pain, lethargy, mucosal bleeding, rising hematocrit with falling platelet count) 1
Significant bleeding 1
Respiratory distress or hypoxemia 2
Hemodynamic instability 1
Altered mental status 2

For patients who develop shock (dengue shock syndrome):
- Administer an initial fluid bolus of 20 mL/kg of isotonic crystalloid solution 1, 2
- Consider colloid solutions for severe shock when available 1
- For persistent tissue hypoperfusion despite adequate fluid resuscitation, vasopressors may be required 1, 2
Blood transfusion may be necessary in cases of significant bleeding 1

Failing to recognize the critical phase (typically days 3-7 of illness) when plasma leakage can rapidly progress to shock 1
Administering excessive fluid boluses in patients without shock, which can lead to fluid overload and respiratory complications 1
Delaying fluid resuscitation in patients showing signs of shock 1
Using aspirin or NSAIDs, which can worsen bleeding tendencies 3, 1
Overhydration during the recovery phase, which can lead to pulmonary edema 1, 6

For pregnant women with dengue fever, acetaminophen remains the safest analgesic option 3
In children, acetaminophen dosing should be carefully calculated based on weight (10-15 mg/kg per dose) 3, 2
After stabilizing hemodynamics and clinical improvement, reduce and discontinue fluid therapy gradually to avoid congestion and other complications 6