Dengue Fever

Clinical courses of DHF

Suggested WHO Classification 2009

A continuum of pathophysiological changes from normal circulation to compensated and decompensated/ hypotensive shock

Adapted from:

Ganong WF. Cardiovascular homeostasis in health and disease. In: Review of

Medical Physiology. 22nd Edition. London: McGraw-Hill; 2005:p.630-46.

 Clinical and Laboratory Criteria for Patients Who Can be Treated at Home

1. Able to tolerate orally well, good urine output and no history of bleeding
2. Absence of clinical alarm signals (refer Table 5)
3. Physical examination:
•     Haemodynamically stable
• pink, warm extremities
• normal capillary filling time (normal <2 seconds)
• good pulse volume
• stable blood pressure
• normal pulse pressure (> 20mmHg)
• no disproportionate tachycardia
•    No tachypnoea or acidotic breathing
•    No hepatomegaly or abdominal tenderness
•    No bleeding manifestation
•    No sign of pleural effusion ascites
•    No alterations in mental state and full GCS score
4. Investigation:
• Stable serial HCT
• In the absence of a baseline HCT level, a HCT value of >40% in female adults and >46% in male adults should raise

CRITERIA FOR HOSPITAL REFERRAL / ADMISSION

1. Symptoms :
• • Alarm signals
• • Bleeding manifestations
• • Inability to tolerate oral fluids
• • Reduced urine output
• • Seizure
2. Signs :
• • Dehydration
• • Shock (refer to Table 1)
• • Bleeding
• • Any organ failure
3. Special Situations :
• Patients with co-morbidity e.g.Diabetes, Hypertension, Ischaemic Heart Disease,    Coagulopathies, 
• Morbid Obesity, Renal Failure,Chronic Liver disease, COPD,
• Elderly (more than 65 years old)
• Pregnancy
• Social factors that limit follow-up e.g. living far from health facility, no transport, patient living alone, etc
4. Laboratory Criteria: Rising HCT accompanied by reducing platelet count

ALGORITHM  FLUID MANAGEMENT IN COMPENSATED SHOCK

ALGORITHM FLUID MANAGEMENT IN DECOMPENSATED SHOCK

DISCHARGE CRITERIA

• Afebrile for 48 hours
• Improved general condition
• Improved appetite
• Stable haematocrit
• Rising platelet count
• No dyspnoea or respiratory distress from pleural effusion or ascites
• Resolved bleeding episodes
• Resolution/recovery of organ dysfunction