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Clinical Spectrum
Asymptomatic
Dengue Fever
(DF)
Without bleeding
With shock
Without shock
DF
DHF
2
Laboratories :
Low platelet count (<100.000 /ul) Hemoconcentration (>20%)
3
Management
Febrile < 7 days ?
No 1 (hospitalized) Dangerous signs: - decrease of consciousness - vomiting - seizure - routine - GI tract bleeding
No 2 (non-hospitalized) Without Dangerous signs : 1.Physical & routine lab studies (3rd day) (dengue blot isnt necessary yet) 2.Education (control) 3.Social indication * : hospitalized (parent request, the house is far from hospital)
: : :
2. Immediately go to the emergency dept with this card, if one of the following sign had shown up:
Severe vomiting Faint Cannot eat/drink Hand/feet are cold and/or restlessness Seizures Epistaxis, Hematemesis, Hematoschezia, or any other bleeding sign
7
5
30/06/05
PEI : A / B x 100 %
Ht, Platelet and Blue Plasma Lymphocyte Changes in DHF Nature Illness
50 45 40 35 30 % 25 20 15 10 5 0 1 2
Fever Phase
250 200 150 X 1000 100 LPB Ht Trombosit 50 0
5
Shock Phase
10
Healing Phase
10
* Write the measures and drugs that given to the patient (solution) 4. Follow-up and epidemiological study in the society
13
Four Criteria of DHF: Fever Bleeding manifestation Increased capillary permeability Platelet count<100.000/mm3
Early dangerous sign: Relieve of the fever Low platelet count Increased hematocrit
Tachycardia
>180 >180 >180 >140 >130 >110
17
Temp
Time of defervescence
Days of illness
18
negative
Platelet count >100.000/ul Outpatient care Control everyday until the fever is relieved Advise the parents
Still Fever >3 days Check Hb, Ht, leukocyte, platelet count
Chart 1 a
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Drink much 2l/day Paracetamol Anticonvulsive if indicated Clinical & Lab monitoring Shock sign Urine output Bleeding Hb,Ht, platelet every 6-12 hours Get better Home
D5% : NaCl 0.9% = 3:1 Maintanace Check Hb, Ht, platelet every 6 12 hours
Increase Ht, Decrease platelet See chart 2 Change IVF to Ringer Lactate 20 DHF
Chart 1 b
RL/RA/NaCl 0,9% or RLD5/NaCl 0,9%+D5, 6-7 ml/kgBW/hour Monitor vital sign/Ht and platelet count every 6 hours
Get better Unrestlessness Strong pulse Blood pressure stable Good urine output (check twice)
Restlessness Respiratory Distress Increase pulse frequency Increase Ht Pulse pressure <20 mmHg Low urine output
Increase IVF speed 10-15 ml/kgBW/hour Increase the IVF speed
5 ml/kgBW/hour
Get better Reduce the IVF
Get better
Chart 2
3 ml/kgBW/hour
Decrease Ht
IVFD stop pada 24-48 jam Bila tanda vital/Ht stabil, diuresis cukup
Get better
Management of DHF
22
Shock
Days of illness
23
Shock DHF
Monitoring
Not recover
Conclusion
Dengue viral infection is varies, DHF must be differed with DF Additional work up and monitoring is the key for managing DHF Diagnose criteria from WHO can only be used for DHF Outcome is depends on the duration of shock recovery
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