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Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
Management of Dengue Fever/ Dengue Hemorrhagic Fever
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Management of Dengue Fever/ Dengue Hemorrhagic Fever

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Management of Dengue Fever and Dengue Hemorrhagic Fever

Management of Dengue Fever and Dengue Hemorrhagic Fever

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  • 1. MANAGEMENT OF DENGUE FEVER DENGUE FEVER
    http://crisbertcualteros.page.tl
  • 2.
  • 3. Seen in children in Southeast Asia during the 1950s.
    Its severe forms (hemorrhagic fever and shock syndrome) may lead to multisystem involvement and death
    Early diagnosis, close monitoring for deterioration & response to treatment are necessary in all cases.
  • 4.
  • 5.
  • 6.
  • 7. Risk factors for developing DHF / DSS:
    Children are more prone to develop DHF / DSS than adults
    DHF / DSS is associated more with well nourished than with under nourished children
    Primary infection in infants born to dengue immune mothers
    Presence of underlying chronic illnesses (eg: heart disease, anaemia, chronic liver disease)
  • 8. Special attention :High-risk dengue patients
    Infants under 1 year of age
    Overweight/obese patients
    Massive bleeding
    Change of consciousness,esp. restlessness,irritability or coma
    Presence of underlying diseases e.g. thalassemia, G-6-P deficiency, heart disease
  • 9. Admission in Dengue Fever
    Abdominal pain – may be intense and sustained
    Bleeding tendencies with Positive tourniquet test
    Cold extremities
    Decreased urine output
    Platelet count < 1 Lakh and PCV rise by >20%
    Persistent vomiting
    Altered mental status -Restlessness or somnolence
  • 10.
  • 11. TREATMENT
    No specific therapy – only symptomatic
    Rest and Plenty of oral fluids
    Use Paracetamol
    Avoid Aspirin and NSAIDs Follow up preferably everyday - from the 3rd day until afebrile for 24-48 hour
  • 12. General measures
    Frequent monitoring of vital signs
    Essential nursing care.
    Stop bleeding with proper techniques (e.g. anterior nasal packing for massive epistaxis)
    Avoid blind invasive procedures (e.g. no nasogastric tube insertion, no gastric lavage)
  • 13. Nutritional support
    Soft, balanced, nutritious diet, juice and electrolyte solution – plain water is not adequate
    Avoidblack- or red-colored food or drinks (may be mistaken for bleeding
    Sedation is needed in some cases to restrain agitated child: Chloral hydrate(12.5-50 mg/kg), orally or rectally recommended.
    Avoid Long-acting sedatives
  • 14. NCPAP (Nasal Continuous Positive Airway Pressure): should be preferred if there is Acute respiratory failure associated with DSS
    Oxygen via face mask/nasal cannula: in case of shock/impending shock.
  • 15. Other treatment
    H2-blockers (ranitidine): Recommended in case of GI bleeding
    Domperidone 1 mg/kg/day in three divided doses in case of severe vomiting for 1-2 days.
    Antibiotic: Not necessary; it may lead to complications
  • 16.
  • 17.
  • 18.
  • 19. FLUID MANAGEMENT
    In young infants without shock- D5 0.3% NaCl
    In patients who already have volume overload, i.e., massive pleural effusion - colloid solutions
    Hydroxyethyl starch at 6%: preferred in children with severe shock; the use of dextran is associated with various adverse reactions
  • 20. WHO guidelines are useful in that they offer an algorithmic approach to fluid resuscitation in DHF and DSS.
    However, the usefulness of these guidelines is limited beyond the immediate resuscitation
    do not address treatment of complicated forms of the disease, like fluid overload and multiple organ failure, which could cause disability or death.
  • 21. If no response to IV fluids:
    Consider and correct:
    Massive plasma leakage
    Concealed internal bleeding – decrease in Hematocrit
    Hypoglycemia – Blood sugar < 60 mg/dL
    Hyponatremia, hypocalcemia – electrolytes
    Acidosis – indicates metabolic acidosis in blood gas analysis
  • 22. Blood transfusion
    Platelet transfusion
    Thrombocytopenia with significant bleeding.
    Platelet count < 10,000/mm3
    DOSE 10-20 mL/kg
    Platelets return to normal within 7-9 days
  • 23. Fresh Whole blood / Packed red cell transfusion
    Significant blood loss > 10% (6-8 mL/kg)
    Concealed internal bleeding
    Hemolysis
    DOSE:
    Fresh whole blood 10 mL/kg/dose
    Packed red cells 5 mL/kg/dose
  • 24. Role of Steroids Ineffective in preventing shock in DHF
    It may cause harm
    Treatment with methyl-prednisolone did NOT show any benefit in a double blind placebo-controlled trial in DSS
  • 25. Complications of DF/DSS
    DIC
    Myocardial dysfunction incl. Cardiomyopathy
    Hepatitis
    Reye-like syndrome
    Encephalitis
    ARDS
    Glomerulonephritis
  • 26. Fluid overload
    AVOID: Early IV fluid therapy- in the febrile phase
    Excessive use of hypotonic solutions
    Excessive use of hypotonic solutions
    Non-reduction in the rate of IV fluid after initial resuscitation
    Non-reduction in the rate of IV fluid after initial resuscitation
    Blood loss replaced with fluids in cases with occult bleeding Blood loss replaced with fluids in cases with occult bleeding
    Treatment: Judicious fluid removal: colloids with controlled diuresis (furosemide 1 mg/kg infusion over 4 hours) or dialysis
  • 27. Electrolyte imbalance
    Hyponatremia
    Hypocalcemia – 10% Cagluconate 1mL/kg/dose, slow IV push every 6 hour
  • 28. Large pleural effusion/ascites
    Careful titration of intravenous fluids.
    Avoid insertion of intercostal drains and tracheal intubation.
    Large pleural effusions during recovery phase after 48 hours
    Furosemide (0.25-0.5 mg/kg at 6 hours interval for 1 to 2 doses)
  • 29. Disseminated intravascular coagulation
    Frequent Clinical assessment
    Regular Coagulation profile: PT, aPTT, fibrinogen, platelet
    Patients with bleeding & DIC have benefited from :
    Heparin therapy + Cryoprecipitate (1 unit per 5 kg body weight)
    Followed by Platelets (4 units/m2 or 10-20 mL/kg) within 1 hr and Fresh frozen plasma (FFP 10-20 mL/kg).
  • 30. Prognosis
    Significant morbidity and mortality can result if early recognition and monitoring of severe forms are not done

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