Beware of Dengue Haemorrhagic Fever this season: Doctors

DO'S AND DON'TS FOR DOCTORS

WHAT TO DO:

•  Cases of Dengue fever/Dengue Haemorrhagic Fever (DF/DHF) should be observed every hour.


• Serial platelet and haematocrit determinations, drop in platelets and rise in haematocrits areessential for early diagnosis of DHF.


• Timely intravenous therapy ñ isotonic crystalloid solution can prevent shock and/or lessen itsseverity.


•  If the patientís condition becomes worse despite giving 20ml/kg/hr for one hour, replace crystalloidsolution with colloid solution such as Dextran or plasma. As soon as improvement occurs, replace
  
  with crystalloid.


•  If improvement occurs, reduce the speed from 20 ml to 10 ml, then to 6 ml, and finally to 3 ml/kg.


• If haematocrit falls, give blood transfusion 10 ml/kg and then give crystalloid IV fluids at the rate of10ml/kg/hr.


• In case of severe bleeding, give fresh blood transfusion about 20 ml/kg for two hours. Then givecrystalloid at 10 ml/kg/hr for a short time (30-60 minutes) and later reduce the speed.


• In case of shock, give oxygen.


•  For correction of acidosis (sign: deep breathing), use sodium bicarbonate.
  

  WHAT NOT TO DO:

  
  
  
  
  
  
  
  • Do not give Aspirin or Brufen for treatment of fever.
  
  
  •  Avoid giving intravenous therapy before there is evidence of haemorrhage and bleeding.
  
  
  • Avoid giving blood transfusion unless indicated, reduction in haematocrit or severe bleeding.
  
  
  • Avoid giving steroids. They do not show any benefit.
  
  
  •  Do not use antibiotics.
  
  
  • Do not change the speed of fluid rapidly, i.e., avoid rapidly increasing or rapidly slowing thespeed of fluids.
  
  
  • Insertion of nasogastric tube to determine concealed bleeding or to stop bleeding (by coldlavage) is not recommended since it is hazardouss
    
                                                      SIGNS OF RECOVERY:
  
  
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    •   Stable pulse, blood pressure and breathing rate
    
    
    • Normal temperature
    
    
    •  No evidence of external or internal bleeding
    
    
    • Return of appetite
    
    
    •  No vomiting
    
    
    •  Good urine output
    
    
    • Stable haematocrit
    
    
    • Convalescent confluent petechiae rashCRITERIA FOR DISCHARGING PATIENTS:
    
    
    
    
    
    
    • Absence of fever for at least 24 hours without the use of anti-fever therapy
    
    
    •  Return of appetite
    
    
    • Visible clinical improvement
    
    
    • Good urine output
    
    
    • Minimum of three days after recovery from shock
    
    
    • No respiratory distress from pleural effusion and no ascites
    
    
    •  Platelet count of more than 50,000/mm3
    
    
    
    

    
    ** Guidelines sourced from National rural health mission guidelines