Dengue shock

Question 1

Initial fluid resuscitation for severe dengue with compensated shock

Answer 1

5-10 ml/kg/h over 1 hour

Question 2

Downtitration of IVF

Answer 2

5-7 ml/kg/hr for 1-2 hours
3-5 ml/kg/hr for 2-4 hours
2-3 ml/kg/hr and then reduce further depending on hemodynamic status

Question 3

1st step prior to initiating fluid resuscitation

Answer 3

Obtain baseline CBC

Question 4

Limit of IVF per day

Answer 4

3 L/ day

Question 5

Monitor Hct every _ hrs or PRN

Answer 5

6 hrs

Question 6

Worsening Hct means elevation of __% from baseline

Answer 6

10%

Question 7

If no improvement after 1 hr of IV resuscitation, give __

Answer 7

2nd bolus of crystalloid/ colloid at 10 ml/kg in 1 hours

Question 8

If still no improvement after 2 hrs, give _

Answer 8

3rd bolus of crystalloid/ colloid at 10 ml/kg in 1 hours

Question 9

If no improvement after 3rd bolus of IVF, consider __

Answer 9

inotropes and refer to tertiary care center

Question 10

If baseline Hct is low and with signs of occult bleeding, transfuse __

Answer 10

fresh whole blood 20 mL/kg or pRBC at 10 mL/kg

Question 11

Type of shock where the patient is lucid, tachycardic, with normal systolic pressure and rising diastolic pressure (narrow pulse pressure); postural hypotension; cool extremities

Answer 11

Compensated shock

Question 12

Type of shock where the patient has altered sensorium, cold and clammy extremities, severe tachycardia with bradycardia in late shock, narrowed pulse pressure

Answer 12

Hypotensive shock

Question 13

Discharge criteria

Answer 13

1. No fever for 48 hours
2. Improvement in clinical status
3. Increasing trend of platelet count
4. Stable hematocrit without IV fluids