Treatment for Dengue and Dengue Hemorrhagic Fever
Treatment of Dengue Hemorrhagic Fever requires hospitalization and aggressive treatment. Fluid Replacement Therapy is one of the important treatment to be started early.
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please inform if age is 54 women, High blood pressure and chronic disease, She has Fever and body pain.She is in ICU for three days.is it advised to get her discharged.Platelet count 1 lac. How severe dengue can be in her condition?
As my Mother in ICU>Please Reply
Dear Yousaf,with Hypertension,another chronic disease,and age above 50,the afebrile period is significant,the patient should be advised about the warning signs for plasma leakaga,i.e, the reduced BP,or reduced pulse pressure[the difference between the upper-systolic and lower-diastolic one,e.g. if it comes down to 100/90.the increased capillary refilling time, the tender liver,and or hemmhorages,reduced urinary output,blood in vomiting,altered mentation,increasing respiratory disconfort. All these may indicate her transition towards shock,which is actually far more important than platelts,particularly in absence of internal or external bleeding . Observe your patient for all this,and then decide about discharge. Regards . P-dopp Peoples Doctors @ facebook.
The platelet count is not the only important determinant of bleeding.
Indications for blood/platelet transfusion as recommended in clinical practice guidelines are:
In cases with significant clinical bleeding, which require blood transfusion. Usually bleeding is > 10% of total blood volume (> 6-8 ml/kg of ideal body weight)
In adults with underlying hypertension or coronary heart diseases and platelet 1.3-1.5, which is the result of liver failure: Major contributing factor for massive bleeding.
There is no evidence to support the use of blood components such as platelet concentrates, fresh frozen plasma or cryoprecipitate. Its use could contribute to fluid overload.
Important instructions for treatment of DHF as per WHO/SEARO guidelines:
If the patient’s condition becomes worse despite giving 20ml/kg/hr crystalloid solution for one hour, replace crystalloid solution with colloid solution such as Dextran or Plasma. As soon as improvement occurs, replace with crystalloid.
In case of severe bleeding; give blood transfusion @ 20ml/kg for two hours. Then give crystalloid IV fluids @ 10 ml/kg/hr for a short time (30 - 60 minutes) and later reduce the speed.
If hematocrit falls, give blood transfusion 10 ml/kg and then give crystalloid IV fluids at the rate of 10 ml/kg/hr. The volume of blood administered should be just enough to raise the red blood cell concentration to normal.