A 28-year-old man presents on day 4 of dengue fever. He now has persistent vomiting, abdominal pain, and hepatomegaly. BP 90/60, pulse 110, platelet 28,000/µL, hematocrit has risen from 36% to 44%. He is not bleeding. What is this stage called and what is the management?

• A Dengue with warning signs — hospital admission, IV crystalloid
• B Severe dengue with plasma leakage — immediate platelet transfusion
• C Dengue without warning signs — outpatient management with oral hydration
• D Dengue shock syndrome — fluid resuscitation with isotonic crystalloid boluses ✓

Explanation

This patient has dengue shock syndrome (DSS): evidence of plasma leakage (hematocrit rise >20% = 36% to >43.2%), compensated shock (BP 90/60, tachycardia). DSS = severe dengue per WHO 2009. Management is immediate IV isotonic crystalloid (Ringer's lactate or normal saline) 10–20 mL/kg over 15–30 minutes, then re-assess. Hematocrit guides subsequent fluid management. Platelet transfusion is reserved for severe bleeding + platelet <10,000, or clinical bleeding + platelet <20,000 — it is not indicated for thrombocytopenia alone. Colloids are used if crystalloids fail to maintain BP.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.