An approach to management of dengue infection in the setting of profound or prolonged shock (WHO DHF Grade IV)*¶
An approach to management of dengue infection in the setting of profound or prolonged shock (WHO DHF Grade IV)*¶
WHO: World Health Organization; DHF: dengue hemorrhagic fever. * The WHO has established a grading for severity of dengue hemorrhagic fever
DHF Grade I – Fever, hemorrhagic manifestation (positive tourniquet test), and evidence of plasma leakage.
DHF Grade II – DHF Grade I plus spontaneous bleeding.
DHF Grade III – DHF Grade I or DHF Grade II plus circulatory failure.
DHF Grade IV – DHF Grade III plus profound shock with undetectable blood pressure and pulse.
Dengue shock syndrome consists of DHF Grade III and DHF Grade IV. ¶ Shock refers to normal systolic pressure but rising diastolic pressure with narrowing pulse pressure. Profound shock refers to hypotension and narrow pulse pressure (systolic minus diastolic pressure ≤20 mmHg). Δ Intravenous crystalloid solutions include normal saline or Ringer's lactate. Colloid solution includes blood products or 10% dextran 40 in normal saline; no other colloid formulations (such as albumin) should be used for management of dengue, and dextran should not be used for initial resuscitation. If 10% dextran 40 in normal saline is not available, crystalloid should be used. ◊ Criteria for clinical improvement include blood pressure rising or normalized, heart rate decreasing, pulse pressure widening, respiratory rate decreasing, skin warm with turgor intact, or sensorium clear. § The patient's clinical status (including vital signs, urine output, and hematocrit) should be evaluated prior to each infusion rate adjustment. ¥ Criteria for lack of clinical improvement include blood pressure decreasing, heart rate increasing, pulse pressure narrowing, respiratory rate increasing, skin cool and clammy with diminished turgor, mental confusion, or restlessness. ‡ Additional interventions include dialysis or plasmapheresis; the clinical approach depends on locally available resources and clinical expertise.
Data from:
World Health Organization. Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. WHO, New Delhi 2011.
World Health Organization. Dengue: Guidelines for diagnosis, treatment, prevention and control. WHO, Geneva 2009.