Discharge Criteria for Dengue Fever
Patients with dengue fever can be safely discharged when they have been afebrile for at least 48 hours without antipyretics, demonstrate resolution or significant improvement of symptoms, maintain stable hemodynamic parameters for at least 24 hours without support, achieve adequate oral intake with urine output >0.5 mL/kg/hour in adults, and show laboratory parameters returning to normal ranges. 1
Clinical Stability Requirements
Temperature Control
- Afebrile for ≥48 hours without use of antipyretics is the primary temperature criterion 1
- This differs from some viral illnesses where shorter fever-free periods suffice, but dengue's critical phase (typically days 3-7) requires longer observation 1
Symptom Resolution
- Resolution or significant improvement of all dengue-related symptoms including headache, retro-orbital pain, myalgia, arthralgia, and any bleeding manifestations 1
- Resolving cough and respiratory symptoms if present 1
- Return to baseline mental status with normal level of activity and alertness 1
Hemodynamic Stability Parameters
Cardiovascular Criteria
- Stable hemodynamic parameters for ≥24 hours without any support, including normal heart rate for age, stable blood pressure, and normal capillary refill time 1
- Absence of tachycardia or tachypnea that would indicate ongoing plasma leakage or compensated shock 1
- Normal pulse pressure without the narrow pulse pressure (<20 mmHg) that characterizes dengue shock syndrome 2
Perfusion Indicators
- Warm and dry extremities with well-felt peripheral pulses 3
- Absence of skin mottling or other signs of poor peripheral perfusion 3
Laboratory Parameters
Hematologic Recovery
- Laboratory tests previously abnormal should be returning to normal ranges, particularly hematocrit and platelet counts 1
- Stable or falling hematocrit indicates resolution of plasma leakage rather than ongoing hemoconcentration 4
- While specific platelet thresholds aren't mandated for discharge, rising platelet counts suggest recovery from the critical phase 5
Adequate Renal Function
- Adequate urine output defined as >0.5 mL/kg/hour in adults demonstrates adequate intravascular volume and renal perfusion 1
Oral Intake Capacity
- Adequate oral intake with ability to maintain hydration without intravenous support 1
- Patient should demonstrate tolerance of oral fluids and foods for at least 12-24 hours before discharge 1
Post-Discharge Monitoring Instructions
Temperature Surveillance
- Patients must monitor and record temperature twice daily after discharge 1
- Return immediately if temperature rises to ≥38°C on two consecutive readings as this may indicate secondary infection or disease recurrence 1
Warning Signs Education
- Return to healthcare facility if any warning signs develop, including persistent vomiting, severe abdominal pain, lethargy or restlessness, mucosal bleeding, or signs of fluid accumulation 1
- Patients should be counseled that the recovery phase can still involve complications requiring medical attention 6
Critical Pitfalls to Avoid
Premature Discharge Risks
- Never discharge during the critical phase (days 3-7 of illness) even if patient appears clinically stable, as plasma leakage can progress rapidly to shock 1
- Do not rely solely on patient feeling better as subjective improvement may precede objective hemodynamic deterioration 6
Inadequate Assessment
- Failure to document 24-hour hemodynamic stability is a common error that leads to readmissions for recurrent shock 4
- Discharging patients with persistent tachycardia or narrow pulse pressure significantly increases risk of progression to severe dengue after discharge 2
Laboratory Misinterpretation
- Rising hematocrit even with clinical improvement indicates ongoing plasma leakage and precludes safe discharge 6
- Thrombocytopenia alone should not delay discharge if all other criteria are met and platelet counts are trending upward 5
Special Considerations
High-Risk Populations
- Pregnant women, infants, elderly, and patients with comorbidities may require longer observation periods even when meeting standard discharge criteria 6
- Patients with barriers to care including inability to return for follow-up or inadequate home monitoring capability should have these issues addressed before discharge 1