Dengue%20(pediatric) Treatment

Parental Education

• Ensure adequate bed rest
• Tepid sponging may be done
• Advise to avoid giving their child Acetylsalicylic acid, Mefenamic acid, Ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids
• Inform that antibiotics are not needed and treatment of dengue consists mainly of appropriate hydration and administration of Paracetamol
• Educate parents or guardians about the warning signs for dehydration: Decreased urination, absence of tears when crying, dry mouth/tongue/lips, sunken eyes, listlessness, agitation, confusion, cold/clammy extremities
• Emphasize the need to monitor for warning signs and when to bring their child to the nearest hospital
  • As temperature starts to decline 3-8 days after appearance of symptoms, the following warning signs should be monitored and should prompt return to the emergency department: Severe abdominal pain, persistent vomiting, red skin lesions, nose or gum bleeding, presence of blood in vomitus or stool, black stool, cold/clammy extremities, difficulty of breathing
• Advise to look for mosquito breeding places in their home and eliminate them

Oral Fluids

• Ensure adequate intake of oral fluids
  • Frequent intake of small amounts of fluid is advisable for patients with nausea and vomiting
• Given to dengue patients with no warning signs to replace losses from fever and vomiting
• Oral rehydration solution (ORS), fruit juices, soup and other fluids that contain electrolytes and sugar may also be given
  • However, fluids containing sugar or glucose may exacerbate hyperglycemia of physiological stress from dengue and diabetes mellitus

Paracetamol (Acetaminophen)

• Given to control pain and fever

Intravenous (IV) Fluid

• IV rehydration is the therapy of choice
• Usually needed for only 24-48 hours
• Stable dengue hemorrhagic fever (DHF) patients admitted in the hospital should be given isotonic solutions (eg D₅ LRS, D₅ Acetated Ringers, D₅ NSS)
• Crystalloid solution has been shown to be safe and effective as colloids in decreasing recurrence of shock and mortality
  • Used as 1st line in fluid resuscitation in moderately severe (compensated) dengue shock
  • 0.9% Saline solution (NSS) is an appropriate choice for initial fluid resuscitation but large volumes may cause hyperchloremic acidosis
  • Ringer’s lactate solution should be given to patients with above normal chloride level if NSS was given initially
    • Avoid use in patients with liver failure and in patients taking Metformin where lactate metabolism is impaired
• Colloid solution (eg dextran, starch, gelatin) is the IV fluid of choice in patients who require immediate blood pressure restoration (eg pulse pressure <10 mmHg)
  • Used as a rescue fluid in patients whose cardiovascular status do not improve after the initial fluid resuscitation
  • Faster than crystalloids to restore cardiac index and decrease hematocrit level in patients with intractable shock
  • Associated with higher risk for allergic reactions and new bleeding manifestations
    • Gelatin has the least effect on coagulation but causes allergic reactions the highest

Blood Transfusion

• Only given to patients with suspected or severe bleeding
• Indications for urgent blood transfusion include decreasing hematocrit level with narrowing pulse pressure, tachycardia, metabolic acidosis, low urine output
• 5-10 mL/kg of fresh-packed red cells or 10-20 mL/kg of fresh whole blood may be given
• Prophylactic platelet transfusion should not be given to children with platelet count <50,000/mm³ and have minimal or no active bleeding  
• May consider plasma transfusion in children with signs of disseminated intravascular coagulation