A 12-year-old boy with laboratory-confirmed dengue is seen on day 4 as his fever subsides. He has persistent vomiting, severe abdominal pain and lethargy. Haematocrit has risen from 38 to 46 percent over 24 hours. Platelet count is 55,000/mm3. There is no bleeding. What is the most appropriate next step?
- A Admit for intravenous isotonic crystalloid with serial haematocrit monitoring ✓
- B Discharge home on paracetamol with advice to return if symptoms worsen
- C Prophylactic platelet transfusion
- D Start empiric broad-spectrum antibiotics
Correct answer: A. Admit for intravenous isotonic crystalloid with serial haematocrit monitoring
Explanation
The period around defervescence is the critical leakage phase of dengue, when plasma shifts out of the circulation; a rising haematocrit with warning signs demands hospital admission and careful IV crystalloid therapy with serial haematocrit monitoring. Prophylactic platelet transfusion is indicated only for active bleeding or a platelet count below 10,000/mm3, so the platelet value alone should not drive that decision. Antibiotics have no role in uncomplicated dengue.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.