A 7-year-old with dengue develops compensated shock: pulse pressure 15 mmHg, cold clammy extremities, capillary refill 4 seconds, hematocrit rising rapidly. Per WHO guidance, what is the appropriate immediate fluid intervention?

• A Colloid bolus 20 mL/kg repeated every hour without reassessment
• B Half-strength saline with dextrose at maintenance rate
• C Fresh frozen plasma 20 mL/kg as first-line volume expansion
• D Isotonic crystalloid 10 to 20 mL/kg given over 1 hour ✓

Explanation

WHO dengue guidelines recommend isotonic crystalloid such as normal saline or Ringer lactate at 10 to 20 mL/kg over one hour as the first bolus in compensated shock, followed by careful reassessment of pulse, pulse pressure, capillary refill, and hematocrit. Maintenance hypotonic fluid cannot restore intravascular volume. Plasma is reserved for specific indications such as severe bleeding, and repeated unmonitored colloid boluses risk fluid overload without the mandatory reassessment that defines safe dengue fluid therapy.

Reference: WHO Handbook for Clinical Management of Dengue, 2012 ed.

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Written and medically reviewed by the StethoPrep medical team.