What are the discharge criteria for a patient with dengue?

Discharge Criteria for Dengue Fever

Patients with dengue fever can be safely discharged when they have been afebrile for at least 48 hours, have improving clinical symptoms, normalizing laboratory values, and no warning signs of severe disease. 1, 2

Clinical Criteria for Discharge

• Patient must be afebrile (without fever) for at least 48 hours without the use of antipyretics 3, 1
• Resolution or significant improvement of symptoms including:
  • Resolving cough and respiratory symptoms 3
  • Improved general condition and return to baseline mental status 3, 1
  • Absence of warning signs (persistent vomiting, abdominal pain, lethargy, restlessness, mucosal bleeding) 1, 2

Laboratory Parameters

• Laboratory tests previously abnormal should be returning to normal ranges 3, 1
• Specific parameters to monitor:
  • Rising platelet count (showing recovery trend) 1, 2
  • Stable or decreasing hematocrit (indicating resolution of plasma leakage) 1, 2
  • Improved white blood cell count if previously abnormal 1

Hemodynamic Stability

• Stable hemodynamic parameters for at least 24 hours without support 3:
  • Normal heart rate for age
  • Stable blood pressure (systolic BP ≥90 mmHg in adults)
  • Normal capillary refill time
  • Warm and dry extremities with well-felt peripheral pulses 3

Adequate Oral Intake

• Patient must demonstrate ability to maintain adequate oral hydration 1, 2
• No persistent vomiting or other gastrointestinal symptoms that would impair oral intake 1
• Adequate urine output (>0.5 mL/kg/hour in adults, >1 mL/kg/hour in children) 3

Post-Discharge Instructions

• Patients should monitor and record their temperature twice daily after discharge 3
• Return immediately to healthcare facility if:
  • Temperature rises to ≥38°C on two consecutive readings 3
  • Any warning signs develop (abdominal pain, persistent vomiting, mucosal bleeding, lethargy) 1, 2
  • Decreased urine output 3
• Continue adequate oral hydration (>2500 mL daily for adults) 1
• Avoid NSAIDs and aspirin; use only acetaminophen for pain or fever 1, 2

Special Considerations

• For patients who were on antiplatelet therapy before admission, clinical judgment should guide whether to resume therapy immediately or delay based on platelet recovery 4
• Patients with comorbidities may require additional criteria to be met before discharge 1
• Patients who experienced severe dengue (dengue hemorrhagic fever or dengue shock syndrome) may need longer observation even after meeting basic discharge criteria 2

Common Pitfalls to Avoid

• Discharging patients during the critical phase (typically days 3-7 of illness) when risk of plasma leakage and shock is highest 2
• Failing to provide clear post-discharge instructions about warning signs requiring immediate medical attention 1, 2
• Overlooking the need for follow-up laboratory tests in patients who had significant abnormalities 1