What is the management for a dengue fever patient with dizziness on day 3 who is conscious and oriented?

Management of Dizziness in Dengue Fever Patient on Day 3

For a dengue fever patient experiencing dizziness on day 3 who remains conscious and oriented, aggressive fluid resuscitation with oral rehydration solution is the primary management strategy, with careful monitoring for warning signs of progression to severe dengue. 1, 2

Assessment and Monitoring

• Day 3 of dengue fever coincides with the beginning of the critical phase (typically days 3-7), when plasma leakage can rapidly progress to shock, making careful monitoring essential 2
• Assess for warning signs of severe dengue, including:
  • Persistent vomiting
  • Abdominal pain/tenderness
  • Clinical fluid accumulation
  • Mucosal bleeding
  • Lethargy/restlessness
  • Hepatomegaly
  • Rising hematocrit with concurrent thrombocytopenia 2
• Monitor vital signs, particularly for tachycardia and hypotension, which may indicate progression to shock 3
• Perform daily complete blood count to track platelet counts and hematocrit levels 1

Management of Dizziness

• Dizziness on day 3 is likely related to one or more of the following factors:
  • Dehydration from fever and reduced oral intake
  • Early plasma leakage leading to relative hypovolemia
  • Electrolyte disturbances 4

Fluid Management

• Oral rehydration is the first line of treatment for patients without signs of shock 1, 3
• Administer oral rehydration solution (ORS) for moderate dehydration 1
• If oral intake is inadequate or patient shows signs of significant dehydration:
  • Consider intravenous fluid therapy with isotonic crystalloids 3
  • Monitor for fluid overload, particularly during the critical phase 5

Symptomatic Treatment

• Position the patient in semi-recumbent position (head of bed raised 30-45°) to reduce risk of aspiration if mental status changes 6
• Acetaminophen (paracetamol) at standard doses (10-15 mg/kg every 4-6 hours, not exceeding 4g/day in adults) for associated headache or myalgia 1
• Strictly avoid aspirin and NSAIDs due to increased bleeding risk 1

Warning Signs Requiring Escalation of Care

• If any of the following develop, immediate hospitalization is warranted:
  • Worsening dizziness with postural changes
  • Development of any warning signs of severe dengue
  • Inability to maintain adequate oral hydration
  • Signs of shock (tachycardia, hypotension, poor capillary refill) 2, 4

Special Considerations

• Neurological manifestations in dengue can range from mild dizziness to severe complications like Guillain-Barré syndrome (rare) 7
• Persistent or worsening dizziness, especially when accompanied by other neurological symptoms, requires further evaluation 7
• Be vigilant for plasma leakage which can be detected early using ultrasonography if available 5

Common Pitfalls to Avoid

• Failing to recognize the critical phase (days 3-7) when plasma leakage can rapidly progress 1, 2
• Administering NSAIDs for symptom relief, which increases bleeding risk 1
• Delaying fluid resuscitation in patients showing signs of dehydration 3
• Overlooking warning signs that indicate progression to severe dengue 2