A 9-year-old boy from Delhi presents during monsoon season with 5 days of high-grade fever, retro-orbital pain, myalgia, and a diffuse flushing rash with islands of sparing. On day 5 his temperature falls but he develops abdominal pain, persistent vomiting, lethargy, and tender hepatomegaly. Platelet count is 40,000/mm3 with rising hematocrit. What is the next best step in management?
- A Start empiric doxycycline for scrub typhus
- B Intravenous fluid resuscitation and close monitoring for plasma leakage ✓
- C Immediate platelet transfusion regardless of bleeding status
- D Discharge home with antipyretics since fever has subsided
Correct answer: B. Intravenous fluid resuscitation and close monitoring for plasma leakage
Explanation
These are World Health Organization warning signs of dengue occurring at defervescence, the period of maximum plasma leakage risk. Management is judicious intravenous crystalloid with serial hematocrit monitoring, because rising hematocrit signals hemoconcentration from leaky capillaries. Prophylactic platelet transfusion is not indicated without significant bleeding or platelet count below 10,000/mm3. Discharging a child with warning signs risks death from shock.
Reference: WHO Guidelines for Diagnosis, Treatment, Prevention and Control of Dengue, 2009 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.