A 22-year-old woman with dengue fever is on day 5 of illness. She is afebrile now but has developed abdominal pain and restlessness. Pulse is 110/min, BP 96/60 mmHg, platelets have fallen from 90,000 to 45,000/mm3, and packed cell volume has risen from 36% to 46%. What is the most appropriate immediate step?
- A Start intravenous isotonic crystalloid and admit for close monitoring ✓
- B Reassure and discharge since fever has subsided
- C Give a single unit of whole blood transfusion
- D Start empirical broad-spectrum antibiotics
Correct answer: A. Start intravenous isotonic crystalloid and admit for close monitoring
Explanation
B rising haematocrit with falling platelets around defervescence signals capillary plasma leakage, the hallmark of the critical phase. Abdominal pain and restlessness are WHO warning signs, and the narrow pulse pressure indicates impending shock. Prompt intravenous crystalloid resuscitation with serial haematocrit monitoring is the correct action. Blood transfusion is reserved for significant haemorrhage or refractory shock after fluids, and antibiotics have no role in uncomplicated dengue.
Reference: WHO Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever, 2011 revised edition ed.
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Written and medically reviewed by the StethoPrep medical team.