A 24-year-old man returns from an endemic region with 5-day history of high fever, severe headache, retro-orbital pain, myalgia, and a maculopapular rash. Total WBC is 2,800/μL, platelets 68,000/μL. Dengue NS1 antigen is positive. On day 5, he develops rising haematocrit (HCT 52%, baseline 42%), ascites, and bilateral pleural effusions. His BP drops to 90/60 mmHg. What is the MOST appropriate immediate management?
- A Platelet transfusion for thrombocytopaenia
- B IV dexamethasone to reduce capillary leakage
- C Crystalloid IV fluid resuscitation with isotonic saline or Ringer's lactate ✓
- D Intravenous aspirin to reduce fever and thrombosis
Explanation
This patient has severe dengue with dengue shock syndrome (DSS) — evidenced by plasma leakage (rising HCT, ascites, effusions) and hypotension. WHO guidelines recommend prompt IV crystalloid resuscitation (isotonic saline or Ringer's lactate) at 10 mL/kg bolus repeated as needed. Platelet transfusion is reserved for spontaneous bleeding with counts <20,000/μL, not merely low counts without clinical bleeding. Corticosteroids are not recommended in dengue (no benefit in trials). Aspirin and NSAIDs are absolutely contraindicated in dengue due to platelet dysfunction and bleeding risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.