World Health Organization Collaborating Centre

Guideline for management of suspected dengue patients at a small health center 1
Guideline for management suspected dengue patients at a small health center 2
Guideline for management and follow up scheme for suspected dengue patients at an OPD
Guideline for volume replacement during critical period in DHF patients
Guideline for volume replacement in patients with propounded shock (grade IV)
Standardized clinical management

Management in convalescence phase

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Thrombocytoperia <100,000 cells/cu.mm., rising Hct 10 - 20%, platelet <100,000 cell/cu.mm. and patient cannot have adequate oral intake.
Shock or impending shock.
Type of IV fluid
Isotonic salt solution, e.g. Acetate Ringer (AR), Lactate Ringer (LR) or normal saline solution (NSS) with or without 5% dextrose (preferably with 5% dextrose).
In young infants, during shock use isotonic solution; if not in shock, use 5% D/N/2.

Amount of IV fluid:

During the critical period of plasma leakage (24 - 48 hours), DHF patients should receive the total amount of IV fluid for maintenance + 5% deficit (M + 5% D). Based on the observation that the average amount of IV fluid given through the period of leakage in DHF grade III patients is equal to that.
In patients whose body weight is more than 40 kg, the total amount of IV fluid should be equal to 2 times the maintenance (2M) (because 2M is less than M + 5% D).
In overweight patients, calculate IV fluid according to the ideal body weight (BW) [(BW x 2) + 8].
In adults, calculate IV fluid based on average BW of 50 kg.

Rate of IV fluid

In non-shock cases, start with:
- 5 ml/kg/hr. (BW between 15 - 40 kg).
- 3 - 4 ml/kg/hr. (BW > 40 kg.).
- 6 - 7 ml/kg/hr. (BW < 15 kg).
In DHF grade III, start with 10 ml/kg/hr.
In DHF grade IV, start with 10 ml/kg IV push or drip free flow for 10 - 15 minutes until blood pressure (BP) and pulse (P) can be measured, then reduce to 10 ml/kg/hr.

Adjusting the rate of IV fluid

00000000It is very important to adjust the rate of IV fluid frequently to avoid fluid overload. In DHF patients, IV fluid should be given at the minimal amount to keep intravascular circulation because if more IV fluid is given, it will leak out into both the pleural and abdominal cavities and cause respiratory distress later. The rate of IV fluid should be adjusted according to:

Clinical conditions: general appearance, capillary refill, appetite.
Vital signs: BP, P, temperature (T) and respiratory rate (RR).
Hct.
Urine output.

00000000The first 6 - 12 hours after shock, BP and P are the two important parameters to determine the rate of IV fluid, but later, consider all parameters together before adjusting the rate.