What is the treatment for Dengue?

Treatment of Dengue

Dengue treatment is primarily supportive with no specific antiviral therapy available; management focuses on careful fluid management, symptom control with acetaminophen only, and close monitoring for progression to severe disease during the critical phase (days 3-7). 1

Symptomatic Management

• Use acetaminophen (paracetamol) exclusively for fever and pain control. 1
• Strictly avoid aspirin and all NSAIDs due to increased bleeding risk from thrombocytopenia and platelet dysfunction. 1
• Encourage resumption of age-appropriate diet as soon as appetite returns. 1

Fluid Management Strategy

For Patients WITHOUT Shock

• Oral rehydration is the cornerstone of treatment for uncomplicated dengue. 1
• Target approximately 2,500-3,000 mL daily fluid intake (roughly 5 or more glasses throughout the day), using water, oral rehydration solutions, cereal-based gruels, soup, or rice water. 1
• Avoid routine bolus intravenous fluids in patients with severe febrile illness who are NOT in shock, as this increases risk of fluid overload and respiratory complications without improving outcomes. 1

For Patients WITH Dengue Shock Syndrome

• Administer 20 mL/kg of isotonic crystalloid (Ringer's lactate or 0.9% normal saline) as a rapid bolus over 5-10 minutes. 1
• Reassess after each bolus for signs of improvement: decreased tachycardia, improved capillary refill, warming of extremities, improved mental status, and adequate urine output. 1
• If shock persists, repeat crystalloid boluses up to a total of 40-60 mL/kg in the first hour before escalating therapy. 1
• Consider colloid solutions (gelafundin, albumin, or dextran) if shock persists after initial crystalloid resuscitation, as colloids achieve faster resolution of shock (RR 1.09,95% CI 1.00-1.19) and require less total volume (mean 31.7 mL/kg versus 40.63 mL/kg for crystalloids). 1

Critical Monitoring Parameters

Daily Laboratory Monitoring

• Perform daily complete blood count to track platelet counts and hematocrit levels. 1
• Watch specifically for high hematocrit with rapidly falling platelet count, which signals impending severe disease. 1

Clinical Indicators of Adequate Perfusion

• Normal capillary refill time (<2 seconds) 1
• Absence of skin mottling 1
• Warm and dry extremities 1
• Well-felt peripheral pulses 1
• Return to baseline mental status 1
• Adequate urine output (>0.5 mL/kg/hour) 1

Warning Signs Requiring Escalation

• Severe abdominal pain 1
• Persistent vomiting 1
• Lethargy or restlessness 1
• Mucosal bleeding 1
• Clinical fluid accumulation (ascites, pleural effusion) 2
• Hepatomegaly 2

Management of Refractory Shock

If shock persists despite adequate fluid resuscitation (40-60 mL/kg in first hour), initiate vasopressor support immediately, as delays in vasopressor therapy are associated with major increases in mortality. 1

• For cold shock with hypotension: titrate epinephrine as first-line vasopressor. 1
• For warm shock with hypotension: titrate norepinephrine as first-line vasopressor. 1
• Begin peripheral inotropic support immediately if central venous access is not readily available. 1
• Target mean arterial pressure appropriate for age and maintain ScvO2 >70%. 1

Management of Bleeding Complications

• Blood transfusion may be necessary in cases of significant bleeding, though this is uncommon with appropriate supportive care. 1
• Continue to avoid all antiplatelet agents and anticoagulants. 1

Critical Pitfalls to Avoid

Fluid Management Errors

• Do NOT continue aggressive fluid resuscitation once signs of fluid overload appear (hepatomegaly, pulmonary rales, respiratory distress); switch to inotropic support instead. 1
• Do NOT use restrictive fluid strategies in established dengue shock syndrome, as moderate-quality evidence shows no survival benefit from colloid restriction, and aggressive fluid management achieves near 100% survival. 1
• Do NOT give routine IV fluid boluses to patients without shock, as this causes fluid overload without benefit. 1

Timing and Recognition Errors

• Do NOT fail to recognize the critical phase (days 3-7 of illness) when plasma leakage can rapidly progress to shock. 1
• Do NOT delay fluid resuscitation in patients with dengue shock syndrome, as cardiovascular collapse may rapidly follow once hypotension occurs. 1
• Blood pressure alone is not a reliable endpoint in children; use the clinical perfusion indicators listed above. 1

Medication Errors

• Do NOT use aspirin or NSAIDs at any point in dengue management. 1

Special Considerations for Pediatric Patients

• Use crystalloids as first-line fluid for resuscitation, with colloids reserved for severe cases. 1
• Consider hospitalization for children with moderate to severe dengue, especially those with respiratory distress or hypoxemia. 3
• ICU admission is indicated for children requiring ventilatory support, having impending respiratory failure, sustained tachycardia, inadequate blood pressure, or altered mental status. 3