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Diagnosed with dengue fever. Not cured by medicine. Looking for suggestion

Aug 2012
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Practicing since : 1999
Answered : 362 Questions
Hi, I'm in Bangkok, Thailand and came down with an extremely debilitating fever about 3 days ago. It was so bad that I checked myself into a hospital; they did blood tests and they came back positive for dengue fever. While my fever isn't gone, the hospital treatment has left me feeling much better. However, I'm surprised as they won't let me leave the hospital until they are convinced that I won't come down with dengue hemorrhagic fever. They are checking my platelet count and won't let me go until they stop going down. That could be several more days.

From what I've read, for standard dengue you don't really need to be hospitalized. Just stay hydrated, rest, and take paracetemol. But here they are pumping me full of every drug in the book. I don't like it. They have also had me on an IV for 2.5 days now - from what I've read on standard dengue, you don't need an IV drip.

So, I figure I can check out of the hospital and if any of the warning signs of DHF come on, come back in. I'm not going to go far from major hospitals until the fever is completely subsided for 2 or three days.

Do you think I should try to convince them to let me go?
Posted Fri, 19 Oct 2012 in Infections
Answered by Dr. Madhuri Patil 2 hours later

I really understand your restlessness. You are right that dengue being a viral fever, unless you see any complications, medications are not necessary as your general health has to be taken care just like any other viral fever.

Now the decision of them to keep admitted for a lot more days depends on their clinical judgement. But you ask them all the readings of your platelet counts. If you see that the counts are going up gradually since you started feeling better, then absolutely no need to stay in the hospital anymore. This is true even though your platelets are less than lower limit of normal range. Then in that case, you can take decision on your own and request them for discharge.

But if the counts are fluctuating then that might be a reason for you being kept there. Another reason could be that you have been suffering from superimposed bacterial infection due to dengue and hence they have started you on some IV drugs. Any patient can ask his/her health care providers frankly what medications they are treating him/her with. So ask them what you are treated with and why? If you are treated for any superimposed infections, then just feel free to request for discharge.

Overall, from you are describing about your health, I would say you can request them for discharge on the basis of increasing trend of platelet counts.

Take care and let me know if you need any further clarification.

All the best.
Above answer was peer-reviewed by
Follow-up: Diagnosed with dengue fever. Not cured by medicine. Looking for suggestion 21 hours later
Thanks for the reply. I don't quite understand why platelet counts need to be monitored so closely. I've read the WHO guidelines on treating Dengue and they make it absolutely clear that you can ride it out at home with a combination of oral rehydration, paracetemol, and rest. The one thing you have to make sure of is that when the fever breaks, for the next 2 days you monitor yourself very carefully for DHF. I think I'm capable of doing that and checking myself into another hospital if I have any of those symptoms (I've lost faith in this hospital due to the fact that they are adamant that I stay here, amongst other strange choices, like keeping me on an IV the whole time, and giving me odd choices of drugs, like Tamiflu).

Does that make sense?
Answered by Dr. Madhuri Patil 26 minutes later

I do not say that they should still keep on checking your platelets. They have already done so and they did so even after you started feeling better, so just ask them what the readings are. If you see that the platelets were never less than normal and you have recovered from your fever to the extent that you are feeling fit, never had a single sign of DHF, and then you do not need to be on Tamiflu treatment.

And even when the platelets were lesser than normal and now on the rising trend then as I had said, you still are not at risk of developing DHF.

So feel free to communicate with your doctors and request them to let you go and make sure you see them back or some other good physician, if at all any alarming symptoms reappear.

From what you are telling, you seem to be fit and need not to be hospitalized any more. Stay calm and communicate nicely with the current providers that you really wish to leave the hospital.

Take care. All the best. Let me know if any other problem.
Above answer was peer-reviewed by
Follow-up: Diagnosed with dengue fever. Not cured by medicine. Looking for suggestion 1 hour later
Well no, I am not 100% better. I still have fever and malaise. And they are checking my platelet count every morning and it has been going down and is now below normal.

Again, my question is: do I really need to be in the hospital and have my platelet counts checked every day until they go back up? I've done a lot of researching - like I said, I've read the WHO guidelines on Dengue treatment - and they all recommend resting at home and a very simple treatment regimen. Nowhere does anybody suggest that you should check in to a hospital and stay there until your platelet counts start rising. Seems that it's normal for the platelet counts to go down while the fever progresses, so why bother monitoring it every day? And when the fever breaks, it's pretty obvious if you are developing DHF as the symptoms are fairly severe.

So even though I still have fever, why can't I go home, treat myself there, and self-monitor for DHF?


Answered by Dr. Madhuri Patil 26 minutes later
Oh, XXXXXXX the platelet counts going down in spite of so many days' history of fever means it is their duty to monitor platelets and also treat you with anti-viral medication.

WHO says dengue fever primary management to be tried when things are not as bad as having debilitating fever/ symptoms. They asked you to get into the hospital as you said you were in bad condition earlier. Once the diagnosis of nature of fever is made they need to keep monitoring you. They will not keep monitoring you once they see upward trend in the platelet counts, even though it is still to reach normal range.

Secondly, symptoms of DHF do not necessarily always come as 'visible' ones like skin patches/ rashes etc. There can be asymptomatic internal bleeding in vital organs leading to serious condition. Plus you are still having fever. So just relax and let them treat you as per their judgements. Do not have negativity about your treatment.

Keep in mind, the WHO guidelines are for general public for primary education and cautions but once somebody develops bad fever and platelets remain in bad shape for longer time, no physician would like to take risk of letting the patient go home.

I hope this ensures you to feel relax. Take care.
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