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Epidemological Aspects
Classification
Dengue Virus Infection
Asymptomatic
Undifferentiated
Fever
Without
Haemorrhage
Symptomatic
Dengue Fever
Syndrome
Unusual
Haemorrhage
Dengue Shock
Syndrome
Diagnosis
Abdominal pain
Hepatomegaly
Shock
Chronology of symptomsDay
1
Classical DF
Prostration
Epigastric
pain
Irritability
Hypotension
Hemorrage
Hepatomegal
Shock
Temp (F) 105
104
103
102
101
100
99
98
97
Hematocrit
S. Protiens
Platelets
--
Restlessness or lethargy
Grade I
In the presence of haemoconcentration, fever and non-specific
constitutional symptoms, a positive tourniquet test is the only
haemorrhagic manifestation
Grade II
Spontaneous bleeding in addition to the manifestation of Grade I
Grade III * (DHSS)
Circulatory failure, pulse pressure less than 20 mmHg but systolic
pressure is still normal
Grade IV * (DHSS)
Profound shock, hypotension or unrecordable blood pressure
Start intravenous fluid (N/2 dextrose saline initially) for those with
poor oral intake
Fluid Therapy
initial IV fluid
@ 6 ml/kg/hr
5% D/NS (5%D/0.45%saline in younger children)
Reduceivrateto5
ml/kg/hr
IMPROVEMENT
NO IMPROVEMENT
Hct. Pulse
Pulse pressure < 20
mmHg
Urine output
IMPROVEMENT
*Increaseivrateto10
ml/kg/hr
NO IMPROVEMENT
IMPROVEMENT
IMPROVEMENT
NO IMPROVEMENT
Reduceivrateto3
ml/kg/hr
SHIFT TO PICU
MANAGE AS DENGUE
SHOCK SYNDROME
FURTHER
IMPROVEMENT
Stopivinfusionafter
24-48hr
uncontrolled bleeding or
Shock management
Role of ECHO
Stable haematocrit
No respiratory distress
Vaccine
Thank You