Dengeee

Pathophysio

•Acute Increase in vascular permeability ->

plasma leakage into extravascular ->
Increase haematocrit -> Hypovolaemic
shock/warning signs
Compensated shock dulu then if prolong
dia akan jadi decompensated.

Lactic acidosis due to tissue hypoxia and

hypoperfusion -> Metabolic Acidosis in
Dengue Shock

Thus, monitor lactate level;

lactate level of <2 mmol/L in a critically ill
patient generally implies that the patient
has adequate tissue perfusion, although
higher levels are not necessarily the result
of tissue hypoxia.
Lab utk Dx
• NS1 - Day 1-3
• IGM - 1st infection: Day 6 - 90 days,
- 2nd infection: IGM+ after day 7
So jgn exclude dengue kalau negative b4 this
periods.
• IGG - Day 7
Management
1. Admit
2. Set 2 large bores IV
3. I/V bolus 20 ml/kg (15-30 mins)- DECOMPENSATED
4. I/V bolus 10 ml/kg – COMPENSATED
5. Maintenance –
➢ Adult: 1.2 – 1.5 ml/kg/hr
➢ Obese: refer formula next slide
➢ Paeds: 5-7ml/kg/hr (warning sign),
23ml/kg/hr (w/o warning sign)
6. Dengue chart
7. Monitor vital signs 2 hourly
8. Repeat FBC 4 hourly
9. Notify health district officer
 Monitor

IVC- Inferior
Vena Cava
So ni nak cek
ABG Body Volume/
- (2-4 hourly) in patients CVP non
with shock mainly for invasive way,
detection of worsening ultrasound then
acidosis by looking at base ukur IVC
excess, bicarbonate, CO2 diameter.
and lactate. Invasive way dia
letak triple
Hypoxaemia is a guide to lumen dkt RA or
warn us of fluid overload, P.Artery then tgk
pleural effusion and level air tu -
interstitial oedema. Baca CVP-
masuk dkt OSCE
last pro
If first line fail or success(maintainance)…
Decompensated..
Management of bleeding
• Gastrointestinal bleeding is one of the most common
haemorrhagic manifestations in dengue infection and it is often
associated with high mortality caused by prolonged shock and
acidosis
• Bleeding is considered significant when it results in haemodynamic
instability;
• HCT not as high as expected for the degree of shock to be explained by
plasma leakage alone – severe shock tapi HCT xdela high mana
• A drop in HCT without clinical improvement despite adequate fluid
replacement (40-60 ml/kg)
• Severe metabolic acidosis and end-organ dysfunction despite adequate fluid
replacement eg; high creatinine, restlessness
• History of prolonged shock
Transfusion of blood in patients with significant
bleeding
• Transfuse blood (5–10ml/kg of packed red cells) and observe the
clinical response. Consider blood components if required.

• Consider repeating the blood transfusion if there is further blood loss

or no appropriate rise in HCT after blood transfusion.

• No significant difference in clinical outcomes and lactate recovery

when transfused with shorter-term storage packed cells compared
with longer-term storage packed cells.
Discharge
- Afebrile>48 hours
- Increase in trend of platelet
- Able to tolerate orally
- Hemodynamically stable
- Improve general vital sign