Management of dengue patient

1. THE CORNERSTONE OF
DENGUE MANAGEMENT
DR LEE OI WAH
PENGARAH HOSPITAL CHANGKAT
MELINTANG
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3. IMPORTANT POINTS
Monitoring dengue cases require the understanding that
dengue infection is a systemic and dynamic disease.
Its clinical, haematological and serological profiles
changing from day to day and accelerate by the hour
during the critical phase, particularly in those with plasma
leakage

Failure in recognising and interpreting the clinical and
laboratory manifestations can lead to delay in appropriate
management thus cause intractable shock and death

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12. CLINICAL MONITORING OF INPATIENTS
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13. LABOROTARY MONITORING OF
INPATIENTS
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15. FLUID THERAPY IN NON-SHOCK
PATIENTS
Often 1.2-1.5 times the normal maintenance will
be required during the critical phase.
Recommendation :
•Encourage adequate oral fluid intake.
•IV fluid is indicated in patients who are vomiting
or unable to tolerate oral fluids.
•IV fluid is also indicated in patients with
increasing HCT (indicating on-going plasma
leakage) despite increased oral intake.
•Crystalloid is the fluid of choice for non shock
patients.
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16. CALCULATIONS FOR FLUID
REQUIREMENT
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18. FLUID THERAPY IN DSS
•Dengue shock syndrome is a
medical emergency.
•Recognition of shock in its early
stage (compensated shock) and
prompt fluid resuscitation will give a
good clinical outcome
•Fluid resuscitation must not be
delayed while waiting for admission
to ICU
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20. FLUID RESUSCITATION IN COMPENSATED
SHOCK
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21. FLUID RESUSCITATION IN DECOMPENSATED
SHOCK
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22. MONITORING RESPONSE TO FLUID
RESUSCITATION
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24. FLUID THERAPY DURING RECOVERY
PHASE
•Reduce or consider discontinuation of IV fluid
therapy when patients begin to show signs of
recovery (usually after 24-48 hours of
defervescence, or the HCT drops in a stable
patient
•Excessive fluid therapy may cause pulmonary
oedema
•Reduce or consider discontinuation of IV fluid
therapy when patients begin to show signs of
recovery (usually after 24-48 hours of
defervescence, or the HCT drops in a stable
patient)
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25. Can we prevent
significant bleeding?
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26. Prevention of hemorrhage in DHF
PEarly recognition of shock
EPrompt correction of shock to prevent acidosis
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27. MANAGEMENT OF BLEEDING
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28. INDICATIONS FOR REFERRAL
TO INTENSIVE
Recurrent or persistent shock
Requirement of respiratory support (non-invasive
and invasive ventilation)
Significant bleeding
Encephalopathy or encephalitis
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29. SUMMARY
1.Dengue is a systemic and dynamic disease. Therefore
disease monitoring is governed by different phases of the
disease.
2. The critical phase (plasma leakage) may last for 24-48
hours. Monitoring needs to be intensified and frequent
adjustments in the fluid regime may be required.

3. Recognition of onset of reabsorption phase is also
important because intravenous fluid regime needs to be
progressively reduced/ discontinued
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30. DOCUMENTATION OF NURSING
CARE AND FLUID MANAGEMENT
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