A 9-year-old boy with dengue fever develops lethargy and cold clammy extremities on day 5. His blood pressure is 90/70 mm Hg with a pulse pressure of 20 mm Hg, haematocrit has risen from 38% to 50%, and platelet count is 60,000/mm3. The most appropriate immediate management is:

• A Oral rehydration and outpatient follow-up
• B Immediate intravenous isotonic crystalloid resuscitation ✓
• C Immediate platelet transfusion
• D Empirical broad-spectrum antibiotics and antimalarials

Explanation

A pulse pressure of 20 mm Hg or less with rising haematocrit defines compensated dengue shock due to plasma leakage, and the treatment is prompt intravenous isotonic crystalloid such as normal saline or Ringer lactate. Platelet transfusion is not indicated merely for counts above 10,000/mm3 without bleeding, and prophylactic transfusion does not prevent shock. Oral fluids are inadequate once warning signs with haemoconcentration have appeared.

Reference: WHO Comprehensive Guideline for Dengue Prevention and Control, 2009 revised classification ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.