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precaution for doctors in dengue

 Dengue Management DON’Ts  do

X DON’T use corticosteroids. They are not indicated and can increase the risk of GI bleeding, hyperglycemia, and immunosuppression.  

X DON’T give platelet transfusions for a low platelet count. Platelet transfusions do not decrease the risk of severe bleeding and may instead lead to fluid overload and prolonged hospitalization.  

X DON’T give half normal (0.45%) saline. Half normal saline should not be given, even as a maintenance fluid, because it leaks into third spaces and may lead to worsening of ascites and pleural effusions.  

X DON’T assume that IV fluids are necessary. First check if the patient can take fluids orally. Use only the minimum amount of IV fluid to keep the patient well-perfused. Decrease IV fluid rate as hemodynamic status improves or urine output increases. 

 

✓ DO tell outpatients when to return. Teach them about warning signs and their timing, and the critical period that follows defervescence.  

✓ DO recognize the critical period. The critical period begins with defervescence and lasts for 24–48 hours. During this period, some patients may rapidly deteriorate. 

✓ DO closely monitor fluid intake and output, vital signs, and hematocrit levels. Ins and outs should be measured at least every shift and vitals at least every 4 hours. Hematocrits should be measured every 6–12 hours at minimum during the critical period. 

✓ DO recognize and treat early shock. Early shock (also known as compensated or normotensive shock) is characterized by narrowing pulse pressure (systolic minus diastolic BP approaching 20 mmHg), increasing heart rate, and delayed capillary refill or cool extremities. 

✓ DO administer colloids (such as albumin) for refractory shock. Patients who do not respond to 2–3 boluses of isotonic saline should be given colloids instead of more saline. 

✓ DO give PRBCs or whole blood for clinically significant bleeding. If hematocrit is dropping with unstable vital signs or significant bleeding is apparent, immediately transfuse blood


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