Professional Documents
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Severe Dengue
Definition
Severe dengue:
1. DHF grade 3 and 4
2. Dengue with severe organ impairment:
Dengue with fulminant hepatitis
Dengue with myocarditis
Dengue with encephalitis
Dengue with respiratory distress
Clinical course of DHF
Clinical assessment for severe
dengue and DHF Grade 3 & 4
During critical phase:
Plasma leakage around defervescence phase:
Evidence of plasma leakage includes:
1. raised HCT (early marker),
2. haemodynamic instability,
Skin- cool and pallor, delayed capillary refilled time
Reduced pulse pressure to < 20 mmHg
Tachycardia
Hypotension SBP< 90 mmHg
3. fluid accumulation in extravascular space (rathe late marker)
Pleural effusion
Ascitis
4. hypoproteinemia.
DHF Grade 3 & 4-clinical assessment
Intense thirst,
Abdominal pain, epigastric pain,
Vomiting,
Restlessness,
Reduced urine output
Altered conscious level,
Shortness of breath and tachypnoea,
Sudden change from fever to subnormal
temperature
Fluid management - When to
initiate IV fluid replacement?
Not taking orally
Dehydration and rising haematocrit
level
Diarrhoea
Vomiting
Decreased sensorium
Compensated shock
Decompensated shock
Fluid management - maintenance
Calculations for normal maintenance of intravenous
fluid infusion per hour:
(Equivalent to Halliday-Segar formula)