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Management Dengue: by Maneesh Kumar Roll No. 31
Management Dengue: by Maneesh Kumar Roll No. 31
of
Dengue
By Maneesh Kumar
Roll No. 31
Diagnosis
• Dengue infection is a systemic and dynamic disease. It has a wide
clinical spectrum that includes both severe and non-severe clinical
complex manifestations.
• After the incubation period, the illness begins abruptly and is followed
by the three phases -- febrile, critical and recovery.
IgG (2nd)
IgM
NS1
Viremia
0 1 2 3 4 5 6 7 8 9
Stepwise approach given by WHO
Investigations:
• Complete blood count
• Hematocrit in early febrile phase, establishes baseline, patients own hematocrit
• Rapid decrease of WBC makes dengue very likely
• Rapid decrease of platelet count with rising hematocrit – suggestive of critical phase of disease.
• LFT, blood glucose, serum electrolyte, urea and creatinine, bicarbonate and lactate, cardiac
enzymes, ECG and urine specific gravity.
• A low serum albumin, high ferritin and a raised CRP are indicative of progress to severe dengue.
On the basis of step 1 determine:
Step 2: Diagnosis, Assessment of
Warning signs
fluids containing electrolyte, ml/kg/hr according to the clinical Rapid isotonic crystalloid
sugar response. In case of shock by colloids
Control of fever: Paracetamol Reassess and repeat hematocrit For Shock
and Tepid sponging. If hematocrit remains the same or Isotonic crystalloid solution at
Immediate hospitalization if no rises slowly then decrease the dose as 5-10ml/kg/hr over 1hr then
improvement or bleeding given above reassess the patient.
manifestation. If it rises, continue with 5- No improvement increase
10ml/kg/hr the fluid infusion rate;
Daily review of patients- WBC and vasopressors and inotropes can
warning signs. Monitor hematocrit, platelet count, be added.
creatinine, electrolyte, LFT.
Treatment of hemorrhagic complicatons:
• Avoid i.m injection
• NSAIDS, antiplatelet, anticoagulant to be withheld temporarily.
• Platelet transfusion if below 10000/mm3 or bleeding manifestations
• Coagulopathy Transfuse plasma
Management of complication properly
Prevention by:
Mosquito vector control
Interruption of human-vector control
No vaccine or antiviral drug available currently…
Hemorrhagic(Bleeding) tendencies,
Thrombocytopenia
No Improvement
Discontinue IV
after 24 hr Reduce to 6 ml/kg/hr then 3 ml/kg/hr
Compensated Shock
PP <=20 mmhg,SBP<90 mmhg, >20% Hct
No Improvement
Improvement
Check Hematocrit
Refractory
IV Inotropes with hypotension
Discontinue IV crystalloid
after 24 hr maintenance
NS 1?
NS-1
Positive
Vaccination?
Dengavaxia: CYD-TDV
Thank You…