The document discusses dengue fever/dengue hemorrhagic fever (DF/DHF), including symptoms, diagnosis, grading of severity, and treatment guidelines. It summarizes several studies comparing different intravenous fluid regimens for resuscitation in dengue shock syndrome (DSS). One study found lactated Ringer's solution performed worse than other fluids. Normal saline may be preferred for most DSS patients. For severe cases, colloids showed faster cardiovascular stabilization than crystalloids. Judicious crystalloid use is effective and safest for moderate DSS.

7. Grading the Severity of Dengue Infection Guidelines for Treatment of DF/ DHF in Small Hospitals WHO, New Delhi, 1999 DF / DHF Grade Symptoms Labs DF Fever with two or more of the ff: headache, retro-orbital pain, myalgia, arthralgia Leukopenia Thrombocytopenia < 100,000 No evidence of plasma loss DHF I Above signs plus positive tourniquet test Thrombocytopenia <100,000 Hct rise >20% DHF II Above signs plus spontaneous bleeding Thrombocytopenia <100,000 Hct rise >20% DHF III Above signs plus circulatory failure (weak pulse, hypotension restlessness) Thrombocytopenia <100,000 Hct rise >20% DHF IV Profound shock with undetectable blood pressure and pulse Thrombocytopenia <100,000 Hct rise >20%

40. Aggressive Management of Dengue Shock Syndrome May Decrease Mortality Rate : A Suggested Protocol by: Ranjit Suchitra, Kissoon Niranjan, Jayakumar Indira Pediatric Critical Care Medicine, Vol 6 (4), July 2005, 412 - 419 W group P group Mean time of death (days) 1.4 4.5 Mortality Rate 22% 7% # of patients dying within 24 hours of admission to the ICU 13 out of 19 2 out 6 Causes of death 7 - Refractory shock 10 - MODS (ARDS and DIC) 2 - Fulminant hepatic failure 5 – Refractory shock 1 - Fulminant hepatic failure

43. Protrombin & Partial Thromboplastin Time as a Predictor of Bleeding in Patients w/ patients with DHF Chua MN, Molanida R, et al South East Asian Journal Tropical Medicine & Public Health,1993; 24(1): 141-143

51. RECOMBINANT ACTIVATED FACTOR ( rFV11a )

62. OXYGEN THERAPY

64. ROLE OF IV Ig

66. ROLE OF STEROIDS

68. DENGUE VACCINE