What are the criteria for discharging a patient with Dengue fever from the hospital?

Discharge Criteria for Dengue Fever

Patients with dengue fever can be safely discharged when they demonstrate clinical stability with afebrile status for >3 days, resolution of warning signs, stable or rising platelet counts (typically >50,000/μL), stable hematocrit without fluid resuscitation, adequate oral intake, and no evidence of plasma leakage or bleeding complications.

Clinical Stability Requirements

Fever Resolution

• Body temperature must return to normal for more than 3 days without antipyretics 1
• This timeframe ensures the patient has passed through the critical phase (typically days 3-7 of illness) when plasma leakage and complications are most likely 2

Hematologic Parameters

• Platelet count should be stable or rising, ideally >50,000/μL, though specific thresholds vary by clinical context 2, 3
• Hematocrit must be stable without ongoing fluid resuscitation, indicating resolution of plasma leakage 4, 5
• Serial monitoring should show no progressive hemoconcentration 4

Resolution of Warning Signs

• No evidence of ongoing plasma leakage (no pleural effusion, ascites, or gallbladder wall thickening on ultrasound if performed) 4, 5
• Absence of persistent abdominal pain or tenderness 2
• No clinical bleeding manifestations 6, 3
• Stable hemodynamics with adequate urine output 2

Functional Capacity

Oral Intake and Hydration

• Patient must demonstrate adequate oral fluid intake to maintain hydration without IV support 2
• Ability to tolerate oral medications if needed 1
• No persistent nausea or vomiting that would compromise hydration 2

Activity Tolerance

• Patient should be ambulatory and able to perform basic self-care activities 1
• No signs of orthostatic hypotension or dizziness 2

Home Care Capability

Caregiver Availability

• A responsible caregiver must be available at home to monitor the patient and recognize warning signs 1, 7
• The caregiver should be capable of seeking immediate medical attention if deterioration occurs 1

Patient Education Completed

• Clear written and verbal instructions provided regarding warning signs 7
• Understanding of when to return for emergency evaluation 7
• Instructions for continued monitoring at home (temperature, fluid intake, urine output) 8

Monitoring Requirements Post-Discharge

Follow-Up Arrangements

• Schedule follow-up within 24-48 hours for clinical reassessment and repeat blood counts 7
• Patients should monitor temperature daily at home 8
• Return immediately for: recurrent fever >38°C, severe abdominal pain, persistent vomiting, bleeding manifestations, lethargy, or decreased urine output 8

Special Considerations

High-Risk Patients Requiring Extended Observation

• Infants, elderly, pregnant women, and patients with comorbidities (diabetes, hypertension, chronic kidney disease) may require longer hospitalization even if meeting basic discharge criteria 2
• Patients with immune thrombocytopenic purpura or other bleeding disorders need individualized assessment 6
• Those with severe dengue (DHF/DSS) during hospitalization require complete resolution of complications before discharge 5, 3

Laboratory Testing Before Discharge

• Final complete blood count showing stable/rising platelets and stable hematocrit 2, 3
• No requirement for negative viral testing (RT-PCR or NS1) for discharge, unlike COVID-19 1

Common Pitfalls to Avoid

• Do not discharge during the critical phase (days 3-7 of illness) even if patient appears stable, as rapid deterioration can occur 2
• Do not rely solely on platelet count; clinical stability and absence of warning signs are equally important 4, 2
• Avoid premature discharge in patients with persistent hemoconcentration, as this indicates ongoing plasma leakage 4, 5
• Ensure adequate patient/caregiver education, as failure to recognize warning signs at home contributes to mortality 4

Documentation Requirements

Discharge Summary Should Include

• Peak fever duration and defervescence date 2
• Lowest platelet count and trend at discharge 3
• Presence/absence of plasma leakage during hospitalization 5
• Any transfusion requirements (platelets, FFP, RBCs) 3
• Clear return precautions and follow-up plan 7