A patient with dengue fever on day 5 of illness has: platelet count 18,000/µL, hematocrit 48% (baseline 38%), BP 90/60 mmHg, cold extremities, and pleural effusion on CXR. According to WHO classification, what stage is this and what is the most critical immediate intervention?

• A Dengue with warning signs; oral rehydration therapy
• B Severe dengue (dengue shock syndrome); IV crystalloid resuscitation ✓
• C Dengue fever; platelet transfusion for thrombocytopenia
• D Secondary dengue infection; immediate corticosteroids

Explanation

This patient fulfills criteria for severe dengue (DSS — Dengue Shock Syndrome): severe plasma leakage evidenced by hematocrit rise >20% (38% to 48% = 26% rise), hypotension with cold extremities, and pleural effusion. Immediate IV isotonic crystalloid resuscitation (10–20 mL/kg bolus, titrated to clinical response) is the cornerstone of management. Platelet transfusion is NOT indicated even with very low platelet counts unless there is active significant bleeding, as transfusion does not prevent hemorrhage and may worsen outcomes. Steroids are not recommended for dengue management.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.