Red Flags
- Severe dengue criteria — severe plasma leakage with shock or fluid accumulation/respiratory distress; severe bleeding; severe organ involvement (AST/ALT ≥1000, encephalopathy) — ICU admission, careful crystalloid[1]
- Warning signs (abdominal pain, persistent vomiting, mucosal bleeding, lethargy/restlessness, tender hepatomegaly, rapid Hct rise + falling platelets) — admit and start IV fluids per protocol[1]
- Pregnant women, infants, elderly, comorbidities (DM, CKD, sickle cell) with dengue — lower threshold for admission regardless of warning signs[1]
- Critical phase (typically days 4–6 after fever onset) when platelets fall and Hct rises — most fluid leakage and shock occur here; close monitoring[1]
First-line treatment
Interventions
- Oral rehydration (Group A — uncomplicated)[1]Adequate oral fluids (water, ORS, soup, fruit juice) with daily review until 24–48 h after defervescence; outpatient management feasible
- IV crystalloid for warning-sign dengue (Group B)[1]Isotonic crystalloid (RL or NS) — start 5–7 mL/kg/h × 1–2 h, reduce to 3–5 mL/kg/h × 2–4 h, then 2–3 mL/kg/h. Reassess Hct and clinical signs every hour. Reduce as Hct stabilises
- Compensated shock (Group C — severe dengue)[1]Crystalloid bolus 5–10 mL/kg over 1 h. If no improvement, repeat. If Hct continues rising despite repeated crystalloid → shift to colloid (gelatin, dextran, albumin). If Hct falls → consider blood transfusion
- Hypotensive shock (decompensated) — fluid resuscitation[1]Rapid bolus 20 mL/kg over 15 minutes; if not improving, consider colloid or blood. ICU level care
- Platelet transfusion ONLY for clinically significant bleeding[1]Routine prophylactic platelet transfusion is NOT recommended even with platelet counts <20 ×10⁹/L. Transfuse for active major bleeding or pre-procedural
First-line drug therapy
| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Paracetamol[1] | Analgesic / antipyretic | 500–1000 mg PO QDS PRN, max 4 g/day | 10–15 mg/kg/dose q4–6h, max 60 mg/kg/day | Avoid NSAIDs, aspirin, steroids — bleeding and Reye's risks |
Paracetamol[1]
Analgesic / antipyretic
- Adult
- 500–1000 mg PO QDS PRN, max 4 g/day
- Paediatric
- 10–15 mg/kg/dose q4–6h, max 60 mg/kg/day
Avoid NSAIDs, aspirin, steroids — bleeding and Reye's risks
Safety-net
- Take only paracetamol for fever; avoid ibuprofen, diclofenac, mefenamic acid, and aspirin — they raise bleeding risk[1]
- Drink oral fluids regularly even if you don't feel thirsty; weigh yourself daily; pass urine ≥6 times in 24 hours[1]
- Return same-day for severe abdominal pain, persistent vomiting, bleeding from gums or nose, lethargy, restlessness, breathing difficulty, or cold extremities[1]
Referral criteria
- Severe dengue (shock, severe bleeding, severe organ involvement)ICU/HDU; haematology if severe bleeding[1]
- Warning-sign dengue (abdominal pain, vomiting, lethargy, mucosal bleeding, Hct rise)Hospital admission for IV fluids and monitoring[1]
- Pregnancy with dengueJoint obstetric and ID care[1]
- Dengue with comorbidity (DM, CKD, sickle cell, immunosuppression)Hospital admission for monitoring even if no warning signs[1]
Clinical summary
Risk-stratified management of dengue across uncomplicated, warning-sign, and severe dengue per WHO/NVBDCP classification, with judicious crystalloid resuscitation.