2012 Dengue Fever Flashcards
What is the typical characteristic of Aedes Aegypti mosquito, carrier of Dengue virus 1-4?
Bites during the day
Protective in Dengue fever
Malnutrition
How is tourniquet test done
- Take BP
- Add 10-20 mmHg to SBP
- Inflate for 15 minutes
- Check appearance of petechaie in antecubital space
What is a positive tourniquet test
More than 20 petechaie in 1 sq. Inch
When do you say there is hematoconcentration
Rise of 15% from baseline hematocrit
True or false. Malnourished individuals are more likely to suffer from shock
False. Malnutrition is protective.
Warning signs in Dengue
Abdominal pain or tenderness Persistent vomiting Clinical fluid accumulation Mucosal bleeding Lethargy, restlessness Liver enlargement more than 2 cm Concurrent rapid decrease in platelet count
Criteria for severe dengue
Severe plasma leakage leading to shock or fluid accumulation with respiratory distress
Severe bleeding
Severe organ involvement with liver AST/SGPT more than 1000, impaired consciousness, impairment in heart and other organs
True or false. Degree of platelet decrease reflect the severity of plasma leakage
False. Increase above baseline hematocrit reflects severity of plasma leakage
Earliest abnormality in dengue
Decrease in total WBC count
Reflect severity of plasma leakage
Increase above the baseline hematocrit
Expected laboratory changes in Day 3-7 of illness
Increase in capillary permeability in parallel with increasing hematocrit levels
Precedes plasma leakage
Progressive leukopenia followed by rapid decrease in platelet count
True or false. Bradycardia is common during the recovery phase of dengue
True
True or false. Recovery of platelet count is typically later than that of WBC count
True.
When does WBC count start to rise in Dengue
Soon after defervescence
True or false. Hematocrit stabilises or may lower due to the dilutional effect of reabsorbed fluid
True.
True or false. During the critical and or recovery phase, excessive fluid therapy is associated with pulmonary edema or congestive heart failure
True.
In the DOH Revised Dengue Clinical Case Management Guidelines, when is Dengue confirmed
Viral culture isolation or PCR
Which Dengue patient requires in-hospital admission
Coexisting conditions such as pregnancy, infancy, old age, diabetes mellitus, renal failure
Living alone
Which Dengue patient may be sent home
Able to tolerate adequate volumes of oral fluids
Pass urine at least once every 6 hours
What is the initial fluid management in Dengue patients with compensated shock
Isotonic crystalloid rate of 5-10 ml/kg/hour
How is IV infusion adjusted in Dengue fever
If clinical with clinical improvement, 5-7 ml/kg/hr for 1-2 hours 3-5 ml/kg/hr for 2-4 hours 2-3 ml/kg/hr for 2-4 hours If patient continues to improve, fluid can be reduced even further
Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. What to do next?
Check hematocrit.
Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit is low
Consider occult or overt bleeding. Initiate transfusion with fresh whole blood
Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit is high.
Administer 2nd bolus of fluid 10-20 ml/kg/hr for 1 hour.
Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit high. No improvement after 2nd IV fluid bolus. What to do next?
Re check hematocrit
Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit high. With improvement after 2nd IV fluid bolus.
Reduce IVF to 7-10 ml/kg for 1-2 hours then reduce further
True or false. Persistent or worsening metabolic acidosis with or without well maintained systolic blood pressure esp whose wiht severe abdominal tenderness or distention is a sign or severe bleeding
True.
