What is the treatment for dengue fever?

Treatment of Dengue Fever

Dengue fever treatment is primarily supportive, focusing on adequate hydration, acetaminophen for pain and fever control, and close monitoring for progression to severe disease, as no specific antiviral therapy exists. 1, 2, 3

Pain and Fever Management

• Acetaminophen (paracetamol) is the only recommended analgesic, dosed at 10-15 mg/kg every 4-6 hours, not exceeding 4 grams daily in adults 1, 4
• Aspirin and NSAIDs are absolutely contraindicated due to increased bleeding risk from platelet dysfunction and potential for hemorrhagic complications 1, 4, 2
• Monitor liver function tests when using acetaminophen, particularly in patients with pre-existing hepatic disease or signs of liver involvement 4
• In pregnant women, acetaminophen remains the safest option; in children, calculate dosing carefully by weight 1, 4

Hydration Strategy

Outpatient Management (No Warning Signs)

• Encourage oral intake of at least 2,500-3,000 mL daily using water, oral rehydration solutions, cereal-based gruels, soup, or rice water 1, 2
• Avoid soft drinks due to high osmolality 2
• Target 5 or more glasses of fluid throughout the day, as this volume reduces hospitalization rates 2

Inpatient Management (Warning Signs Present)

• Administer oral rehydration solutions for moderate dehydration in patients without shock 1, 2
• Avoid routine bolus intravenous fluids in patients with severe febrile illness who are NOT in shock, as this increases fluid overload risk without improving outcomes 2

Critical Monitoring Parameters

• Perform daily complete blood counts to track platelet counts and hematocrit levels, particularly during the critical phase (days 3-7 of illness) 1, 2
• Watch for warning signs of severe dengue: persistent vomiting, severe abdominal pain, lethargy or restlessness, mucosal bleeding, rising hematocrit with rapidly falling platelet count 1, 4, 2
• Monitor for adequate tissue perfusion: normal capillary refill time, warm and dry extremities, well-felt peripheral pulses, baseline mental status, adequate urine output (>0.5 mL/kg/hour in adults) 1, 2

Management of Dengue Shock Syndrome

Initial Fluid Resuscitation

• Administer 20 mL/kg of isotonic crystalloid (Ringer's lactate or 0.9% normal saline) as a rapid bolus over 5-10 minutes 1, 2
• Reassess immediately after each bolus for signs of improvement (reduced tachycardia, improved blood pressure, better perfusion) 1, 2
• Repeat crystalloid boluses up to a total of 40-60 mL/kg in the first hour if shock persists 2

Escalation to Colloids

• Consider colloid solutions (dextran, gelafundin, or albumin) for severe shock with pulse pressure <10 mmHg 1, 2
• Moderate-quality evidence shows colloids achieve faster resolution of shock (RR 1.09,95% CI 1.00-1.19) and reduce total bolus volume needed (31.7 mL/kg versus 40.63 mL/kg for crystalloids) 2

Vasopressor Support

• For cold shock with hypotension: titrate epinephrine as first-line vasopressor 2
• For warm shock with hypotension: titrate norepinephrine as first-line 2
• Begin peripheral inotropic support immediately if central access is unavailable, as delays in vasopressor therapy increase mortality 2

Management of Hemorrhagic Complications

• Blood transfusion may be necessary for significant bleeding, particularly in adults with massive hematemesis from peptic ulcer disease 2, 5
• Internal hemorrhage frequency increases with age, while shock and plasma leakage are more prevalent in younger patients 5

Critical Pitfalls to Avoid

• Do not delay fluid resuscitation in patients showing signs of shock—cardiovascular collapse may rapidly follow once hypotension occurs 1, 2
• Stop fluid resuscitation immediately if hepatomegaly, pulmonary rales, or respiratory distress develop—switch to inotropic support instead 2
• Do not continue aggressive fluid resuscitation once signs of fluid overload appear, as this increases mortality 2
• Do not fail to recognize the critical phase (days 3-7) when plasma leakage can rapidly progress to shock 1, 2
• Never use aspirin or NSAIDs when dengue cannot be excluded 1, 2

Discharge Criteria

Patients can be safely discharged when ALL of the following are met: 1

• Afebrile for ≥48 hours without antipyretics
• Resolution or significant improvement of symptoms
• Stable hemodynamic parameters for ≥24 hours without support
• Adequate oral intake and urine output (>0.5 mL/kg/hour in adults)
• Laboratory parameters returning to normal ranges

Post-Discharge Instructions

• Monitor and record temperature twice daily 1
• Return immediately if temperature rises to ≥38°C on two consecutive readings or if any warning signs develop 1