An 8-year-old boy with 4 days of high fever and body ache is noted on day 4 to have a rising hematocrit, platelet count of 40,000 per cubic mm, abdominal tenderness, and two episodes of vomiting. His fever is settling but he becomes restless with cold clammy extremities and weak pulse. What is the most appropriate immediate management?

• A Broad-spectrum antibiotics with antimalarials
• B Immediate intravenous isotonic crystalloid bolus with close monitoring of hematocrit ✓
• C Platelet transfusion to correct the count below 50,000
• D Oral paracetamol with ibuprofen and discharge advice

Explanation

The critical phase of dengue begins around defervescence, when increased capillary permeability causes plasma leakage, hemoconcentration, and compensated shock even though fever is improving. Standard management is prompt intravenous isotonic crystalloid resuscitation with serial hematocrit monitoring. Platelet transfusion does not prevent bleeding in dengue and counts alone do not guide transfusion. Ibuprofen is contraindicated due to gastritis and bleeding risk, and the picture reflects leakage rather than a second infection requiring antimicrobials.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.