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8 yr old girl with fever ,headache,bodyache is admitted to ward. she vomits and is recorded to have low bp and shifted to icu . meanwhile you receive her lab report with platelet of 1lakh and hct of 48%. crt is 3 seconds ,hr 140/mt . no overt bleeding. cxr ,usg not done
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she improves with a bolus and is now stable. she continued to improve but after 24 hour she develops abdominal pain and vomiting. crt is 2 second , bp nl for age ,I/v was being tapered is stepped up
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no platelet transfusion was given even though platelet dropped to 60,000
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she improved ,but developed prutic rash with good appetite in 2 days time
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is the management on current protocols ?what modifications we can make in our setting?
- acute febrile illness of 2-7 days with any two of the following headache,retroorbital ain,myalgia,arthralgia,rash,bleeding manifestation ,we can consider dengue fever
- dengue hemorrhagic fever is considered when features of dengue fever+with hemorrhagic tendency(positive tourniquet test ,petechaiae ecchymosis, bleeding from mucosa ,skin or other sites)+thrombocytopenia(<1 lakhs)+plasma leakage(asites,pleural effusion,hypoproteinemia)
- dengue shock syndrome DHF+hypotension,circulatory failure, weak thread pulse,narrow pulse pressure <20% cold,clammy skin ,restlessness
- probable dengue- clinical fatures of DF or nOn ELISA NS-1 IGM POSITIVE(rapid tests are of poor sensitivity and specificity)
- confirmed DENGUE-NS-1 IGM by ELISA or IG M ANTIBODY by ELISA
- SEE THE ALGORITHM FOR FURTHER MANAGEMENT
- DENGUE 2015 CHARTS
- DENGUE ADMISSION CRITERIA
- DENGUE CLASSIFICATION DD 2015
- DENGUE AT PRIMARY LEVEL
- DENGUE PLATELET TRANSFUSION
- DENGUE LAB
- DENGUE PATHOGENESIS
Superintendent, ICH.