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 are essential for early diagnosis of DHF.
·
Timely intravenous therapy – isotonic crystalloid solution can prevent
shock and/or lessen its severity.
·
If the patient’s condition becomes worse despite giving 20ml/kg/hr for
one hour, replace crystalloid solution 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 of 10ml/kg/hr.
·
In case of severe bleeding, give fresh blood transfusion about 20 ml/kg
for two hours. Then give crystalloid 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 the speed of fluids.
·
Insertion of nasogastric tube to determine concealed bleeding or to stop
bleeding (by cold lavage) is not recommended since it is hazardous.
SIGNS OF
RECOVERY:
·
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 rash
CRITERIA
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
If you or any family member is suffering from
suspected dengue fever, it is important to carefully watch yourself or relative
for the next few days, since this disease can rapidly become very serious and
lead to a medical emergency.
The complications associated with Dengue
Fever/Dengue Haemorrhagic Fever usually appear between the third and fifth day
of illness. You should therefore watch the patient for two days even after
fever disappears.
WHAT TO
DO:
·
Keep body temperature below 39oC. Give the patient paracetamol (not more than
four times in 24 hours) as per the dose prescribed below:
|
Age
|
Dose
(tablet 250 mg)
|
Mg/dose
|
|
|
|
|
|
<1 year
|
¼ tablet
|
60
|
|
|
|
|
|
1-4 years
|
½ tablet
|
60-120
|
|
|
|
|
|
5 and above
|
1 tablet
|
240
|
|
|
|
|
·
Give
large amounts of fluids (water, soup, milk, juice) along with the patient’s
normal diet.
·
The patient should take complete rest.
·
Immediately
consult a doctor if any of the following manifestations appear:
o Red spots or points on the skin;
o bleeding from the nose or
gums;
o frequent vomiting;
o vomiting with blood;
o black stools;
o sleepiness;
o constant crying;
o abdominal pain;
o excessive thirst (dry
mouth);
o pale, cold or clammy skin;
o difficulty in breathing.
WHAT NOT
TO DO:
·
Do not wait in case the above symptoms appear. Immediately consult a
doctor. It is crucial to quickly get treatment in case of these complications.
·
Do not take Aspirin or Brufen or Ibubrufen.
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