A 32-year-old returns from Southeast Asia with a 5-day febrile illness. On day 5, fever breaks and she develops dengue warning signs: abdominal pain, vomiting, bleeding gums, lethargy, and haematocrit rise from 38% to 47% with platelet count 28,000/μL. The CORRECT management step is:
- A Administer prophylactic platelet transfusion when count < 50,000/μL
- B Start IV methylprednisolone to prevent dengue shock syndrome
- C Hospital admission with IV fluid (isotonic crystalloid) guided by clinical reassessment every 1–4 hours; haematocrit monitoring ✓
- D Administer aspirin for analgesic effect and platelet anti-aggregation
Explanation
WHO dengue management guidelines classify this as dengue with warning signs — requiring hospital admission and close monitoring. The critical phase involves plasma leakage (haemoconcentration = haematocrit rise ≥20% from baseline) with or without frank shock. Management is careful IV fluid resuscitation with isotonic crystalloids (not colloids as first-line) titrated by haematocrit, urine output, and vital signs. Prophylactic platelet transfusion is not recommended unless there is significant bleeding or pre-procedural risk. Aspirin and NSAIDs are contraindicated due to bleeding risk. Corticosteroids have no proven benefit.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.