DF and DHF management

Posted 14 September, 2009 - 09:29 by steve

For the management, we need to know the grade if DF or DHF grade 1,2,3,or 4

Here is WHO creteria

Plasme  Leakage Platelet Circulatory collapse Haemorrhagic manifestations
DF No Variable Absent Variable
DHF I Present <100 Absent Positive tourniquet test (or easy bruising)
DHF II Present <100 Absent Spontaneous bleeding with or without positive tournequet test
DHF III Present <100 PP <20 mmHG or Hypotension for age Spontaneous bleeding with or without positive tournequet test
DHF IV Present <100 Pulse and BP undetectable Spontaneous bleeding with or without positive tournequet test

Dengue Fever

Most are self-limiting, but may have a maculopapular recovery rash and prolonged lethargy and depression after recovery

  • Encourage oral fluid
  • Paracetamol

DHF

For grade I and II

  • Encourage oral fluid
  • Monitor vital signs closely
  • Monitor Haematocrit and platelet (may warn of  deterioraton to Grade III and IV)

 For grade III and IV (DSS)

  • Monitor CVP if possible
  • IV crystalloid (10-20 ml/kg/h) followed by IV colloid if shock persits
  • Watch carefully for overload

My suggestion: Grage II and III is quite different in management. I think we need more clear cut indicator/figures to start intravenous fluid. BP and/or haemocrit are important indicators?

Source: Lecture notes on Tropical Medicine 6th (2009) edition by Geoff Gill & Nick Beeching

ISBN 978-1-14051-8048-1

 

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