Beta-Glucan (CM-Glucan) Should NOT Be Administered in Dengue
Do not give beta-glucan (cm-glucan) syrup to this child—there is no evidence supporting its use in dengue, and it is not part of standard dengue management. 1
Standard Management for Day 3 Dengue Without Fever
Current Clinical Status Assessment
- Day 3 represents the critical phase (typically days 3-7) when plasma leakage can rapidly progress to shock, even in afebrile patients 1, 2
- The absence of fever does NOT indicate improvement—defervescence often marks the beginning of the critical phase when complications develop 1
Appropriate Management Protocol
Hydration Strategy:
- Encourage oral rehydration with 5 or more glasses of fluid throughout the day, targeting approximately 2,500-3,000 mL daily 1
- Use any locally available fluids including water, oral rehydration solutions, cereal-based gruels, soup, and rice water—avoid soft drinks due to high osmolality 1
Monitoring Requirements:
- Perform daily complete blood count to track platelet counts and hematocrit levels 1
- Watch for warning signs of progression to severe disease: high hematocrit with rapidly falling platelet count, severe abdominal pain, persistent vomiting, lethargy or restlessness, and mucosal bleeding 1, 2
- Monitor for signs of shock: tachycardia, hypotension, capillary refill time ≥3 seconds, poor peripheral perfusion, and altered mental status 1, 2
Symptomatic Treatment:
- Use acetaminophen (paracetamol) ONLY for pain and fever management 1
- Strictly avoid aspirin and NSAIDs due to increased bleeding risk 1, 3, 2
Critical Pitfalls to Avoid
- Do NOT administer routine bolus IV fluids to this child who is not in shock—this increases risk of fluid overload and respiratory complications without improving outcomes 1, 3, 2
- Do not assume the child is improving simply because fever has resolved—this is when complications typically emerge 1
- Do not delay seeking medical attention if warning signs develop, as dengue shock syndrome can progress rapidly 1, 2
When to Escalate Care
Immediate fluid resuscitation (20 mL/kg isotonic crystalloid bolus over 5-10 minutes) is indicated if:
- Signs of shock develop: capillary refill ≥3 seconds, tachycardia, hypotension, altered mental status 1, 2
- Warning signs appear: severe abdominal pain, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy 1, 2
Regarding the beta-glucan: There is no role for immunomodulators, supplements, or unproven therapies in dengue management—treatment remains supportive with emphasis on close monitoring, recognition of warning signs, and appropriate fluid management when indicated 1, 4, 5