A 40-year-old woman presents with 5 days of fever (40°C), severe myalgia, retro-orbital pain, and a positive NS1 antigen test. On day 6, platelet count drops from 150,000 to 42,000/μL. She develops abdominal pain and her haematocrit rises from 38% to 46%. She remains haemodynamically stable with BP 100/70 mmHg and good urine output. The WHO dengue classification and appropriate management is:
- A Dengue without warning signs; discharge home with paracetamol
- B Severe dengue (dengue shock syndrome); immediate platelet transfusion
- C Dengue with warning signs (abdominal pain + rising haematocrit indicating plasma leakage); admit for IV fluid resuscitation with close monitoring ✓
- D Dengue without warning signs; NSAIDs for pain control
Explanation
Per WHO 2009 dengue classification, this patient has dengue with warning signs: abdominal pain/tenderness and rising haematocrit (≥20% rise — 38% to 46% is a 21% rise), indicating plasma leakage. She is haemodynamically compensated (not yet dengue shock). Management requires hospital admission, IV fluid resuscitation (isotonic crystalloid), and close monitoring (hourly vital signs, serial haematocrit). NSAIDs are contraindicated in dengue due to bleeding risk. Platelet transfusion is not indicated unless <20,000 with bleeding or <10,000. Dengue shock is defined by hypotension or narrow pulse pressure.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.