THE CORNERSTONE OF DENGUE MANAGEMENT

DR LEE OI WAH

PENGARAH HOSPITAL CHANGKAT MELINTANG

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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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CLINICAL MONITORING OF INPATIENTS0

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LABOROTARY MONITORING OF INPATIENTS

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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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CALCULATIONS FOR FLUID REQUIREMENT

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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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FLUID RESUSCITATION IN COMPENSATED SHOCK

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FLUID RESUSCITATION IN DECOMPENSATED SHOCK

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MONITORING RESPONSE TO FLUID RESUSCITATION

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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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Can we prevent significant bleeding?

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Prevention of hemorrhage in DHF

Early recognition of shock Prompt correction of shock to prevent

acidosis

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MANAGEMENT OF BLEEDING0

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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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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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DOCUMENTATION OF NURSING CARE AND FLUID MANAGEMENT

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