An 8-year-old boy has had high fever for 4 days. He now reports severe abdominal pain and has vomited three times in the past 6 hours. He appears lethargic with cold clammy extremities, pulse 140/min, BP 86/54 mmHg, hematocrit 52%, and platelet count 38,000/mm3. What is the most appropriate immediate management?

• A Platelet transfusion
• B Intravenous isotonic crystalloid bolus of 20 mL/kg over 30 minutes ✓
• C Oral rehydration and antipyretics with outpatient review after 24 hours
• D Empirical ceftriaxone and blood culture

Explanation

Abdominal pain, persistent vomiting, lethargy, hemoconcentration, and shock define severe dengue with plasma leakage during the critical phase around defervescence. The immediate priority is prompt intravenous isotonic crystalloid resuscitation at 20 mL/kg, with reassessment and colloid or further boluses if shock persists. Platelet transfusion does not correct the capillary leak driving shock and is reserved for significant bleeding, which makes it the most tempting but incorrect distractor.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.