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Suggest treatment for severe dengue

Answered by
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Dr. Michelle Gibson James

General & Family Physician

Practicing since :2001

Answered : 15762 Questions

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Posted on Thu, 19 Apr 2018 in Infections
Question: Hi, my brother is diagnosed with severe dengue in the Philippines. He's in the ICU at the moment. I am overseas and would like to know if his life is in danger. His blood pressure and temperature are back to normal however he has a rapid heart rate. He's already gotten a platelet and blood transfusion and now in oxygen therapy. Thank youyu
doctor
Answered by Dr. Michelle Gibson James 35 minutes later
Brief Answer:
can be fatal but most persons recover with appropriate treatment

Detailed Answer:
HI, thanks for using healthcare magic

Based on the fact that he needed platelets and blood, he may have dengue hemorrhagic fever, which, as you stated, is a severe serious form of dengue.

DHF can be potentially fatal but many persons recover from it with appropriate treatment.

The decrease in platelets is one of the reasons bleeding can occur internally. If the platelets have gone up with the platelet transfusion, this is good. If not, he would need repeated transfusion.

In addition, he would need to given a lot of IV fluids, which they are likely doing for him in ICU.

Dengue hemorrhagic fever (DHF) can unfortunately sometimes result in a person's body going into shock which means that there is decreased blood supply to some of the organs.
This can affect the blood pressure, pulse. It can be associated with low body temperature, abdominal pain and vomiting.
He would be monitored to see if there is any indication of shock

Once treated, he should recover. Persons who develop shock are discharged if--(1)no fever for at least 24 hours, without medication
(2)appetite improving
(3)good urine output-- meaning have enough fluids in the body and kidneys working
(4)stable hematocrit- this is part of complete blood count
(5)at least 48 hours since recovered from shock
(6)no problems breathing
(7)platelets greater than 50 000 cells /μl

I hope this helps, feel free to ask any other questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 9 minutes later
Thank you so much for a very detailed answer, I appreciate it doctor. He stopped vomiting blood, his stool color is back to normal and he's been urinating alot today. The only thing that bothers me is the very rapid heart rate. Should I be worried?
doctor
Answered by Dr. Michelle Gibson James 8 minutes later
Brief Answer:
may need more fluid replacement,

Detailed Answer:
HI

The increase in heart rate may indicate that he still needs more fluid replacement which they are no doubt continuing.

When our body's are dehydrated, our pulse rate increases.

If he is getting enough fluids and the pulse remains elevated then they maybe concerned that there is blood loss occurring (may be small amount) internally. Loss of blood also cause an increase
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 5 hours later
If its blood loss occurring, is that a bad thing? How to stop it from happening? Is my brother in stable condition with everything being normal (BP, no vomiting, frequent urinating) except heart rate? Thank you doctor. I have not been able to sleep not knowing if my brother is safe or not.
doctor
Answered by Dr. Michelle Gibson James 6 hours later
Brief Answer:
repeated transfusions if necessary

Detailed Answer:
HI

Sorry for the delayed reply

Repeating the platelet transfusion , if it is still low, would decrease bleeding.

If there is continued blood loss, this would be problem that can be addressed by the platelets and replacing the blood.

The fact that the other parameters are normal is good and indicates that he is hopefully on the right track
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 7 hours later
Hi doctor. I just found out that he only had blood transfusion because when they were about to transfer, platelets, it went up.

Also, they have to put tube because there's water in his lungs, what does it mean?
doctor
Answered by Dr. Michelle Gibson James 3 hours later
Brief Answer:
blood vessels can become 'leaky'

Detailed Answer:
HI

The blood vessels can become 'leaky' (capillary hyperpermeability) during severe dengue and the fluid can leak into surrounding tissues such as the lungs.
Also the heart can sometimes temporarily (return to normal after), not work as it should in some persons and this can cause a back up of fluid in the lungs.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 19 minutes later
Is fluid in the lungs dangerous or should I not worry about this? They injected something so he can pee the fluid out. Also he has developed rash on his skin.
doctor
Answered by Dr. Michelle Gibson James 57 minutes later
Brief Answer:
can affect lung function

Detailed Answer:
HI

It can affect his breathing because the fluid would affect the function of the lungs but the tube they would have placed would likely to make sure that he is supplied with enough oxygen and they would likely be monitoring his levels
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 7 hours later
Why does he have rash again?
Also what are the ways to suck out the fluid? How long does it take?

Thank you doctor.
doctor
Answered by Dr. Michelle Gibson James 5 hours later
Brief Answer:
lasix can be given for excess fluid

Detailed Answer:
HI

Rash can recur in dengue hemorrhagic fever. It may sometimes , in DHF (dengue hemorrhagic fever), be due to bleeding under the skin.

The treatment of the fluid is mainly supportive , this means making sure that he is still getting enough oxygen to his organs though they are congested/full with fluid.

There are medications that can be given to help get rid of excess fluid eg lasix. This starts to work within a few hours for most persons
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 22 hours later
i doctor. I am now in Philippines to see my brother. I cried when I saw him because its so hard seeing him in that state.


what do these things mean?
The doctor told us that he woke up to ask for food?
He has not pooped in a while. Is that because he has not eaten real food? When can he start eating again?
doctor
Answered by Dr. Michelle Gibson James 31 minutes later
Brief Answer:
increased appetite means that he is healing

Detailed Answer:
HI

I can only imagine how heart breaking it must be for you, would be the same for me if it were my brother.

The fact that he asked for food is a really good sign, it means that his appetite is returning. A increase in appetite normally occurs when a person is recovering

The decrease in bowel movements would occur as a result of not eating, there is very little or nothing to pass out.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 1 hour later
My brother seems to be annoyed easily. Why is that? And he moves alot
Also is the fluid in his lungs nothing to worry about? ( he's been urinating it out everytime he is injected with a medicine)


Thank you doctor.
doctor
Answered by Dr. Michelle Gibson James 7 hours later
Brief Answer:
the medication is working to get rid of extra fluid

Detailed Answer:
HI

Yes, the medication, which is a diuretic (used to get rid of excess fluid), would make him urinate when it is used. It is doing its job to get rid of extra fluid, including the fluid in the lungs

He has been through a major illness , admitted to an intensive care unit and is likely still not feeling like himself. It is expected to behave somewhat differently
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 4 hours later
Hi doctor, he had a sudden rise in body temperature that comes and go.

his whiteblood cells is reportedly higher than RBC is this okay?
also he seems very tired. is this normal? i thought he was getting better

Also his legs and arms are swelling. why is that?
doctor
Answered by Dr. Michelle Gibson James 29 minutes later
Brief Answer:
wbc and rbc values are not compared to each other

Detailed Answer:
HI

Fatigue is very common and expected after a major illness. It can actually persist for weeks after the illness has resolved.
Even after a cough/cold persons can be tired for 1 to 2 weeks after.

The fact that the white cell is higher than the RBC is not as important as the actual value. It matters if the white cell is within the normal range for white cell count and if the RBC is in its normal range
They look at two different things and have two different normal ranges, they are not to be compared.

He is still fighting infection and this would cause the temperature to vary

It is understandable to be concerned, your family may need to schedule a meeting with his doctors so that all of you can be clearly told how he is doing

When laying down for a long period of time, fluid can accumulate in the limbs
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 36 hours later
Hi doctor, I thought everything was going well but my brother might need another blood transfusion because his hemoglobin and platelet counts are low. He also had not peed today without the assistance of the thing that makes him urinate which causes his bloatedness. What's going on? Thank you doctor
doctor
Answered by Dr. Michelle Gibson James 8 hours later
Brief Answer:
seems to be still in the dengue hemorrhagic phase

Detailed Answer:
HI

He does not seem to be out of the dengue hemorrhagic phase as yet, if his counts are still low.
His system may also be in dengue shock syndrome which is shock that can occur with severe cases of dengue, mentioned previously. It causes reduced blood supply to the organs.

Can only imagine how difficult this must be for your family.

It would be best to have a meeting to discuss his present situation and prognosis with his doctors
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 2 hours later
The doctor told us he's fine as of now but it still worries us. though his blood pressure is okay and heart rate, and his breathing has improved so much. only blood count and fever are unstable. what can we do about this? i thought the critical phase was only 3 days. :( thought he was recovering cause he developed small rashes (convalescent rashes) few days ago.
doctor
Answered by Dr. Michelle Gibson James 35 minutes later
Brief Answer:
supportive treatment and monitoring

Detailed Answer:
HI

The blood count and platelet are important indicators of recovery. Fever is also important

Supportive care which he is receiving right now with transfusions and medications as necessary, are the main aspects of treatment.
This supportive treatment with monitoring is the main treatment

The fact that his breathing, blood pressure and heart rate are all normal is a good sign.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 3 minutes later
If he gets another transfusion, will his counts be back to normal? Is there a possibility it will decrease again? what causes decrease of blood count?
doctor
Answered by Dr. Michelle Gibson James 1 hour later
Brief Answer:
yes, can decrease again

Detailed Answer:
Hi

Platelets are destroyed in dengue, in addition it is thought that the there may be a decreased production of platelets and other parts of the blood in the bone marrow (this also causes a decrease in platelet levels).

it is possible, after receiving a transfusion, that they may decrease again
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 7 hours later
what do I have to do to make the platelets and blood go up? what foods help? hes about to do another blood transfusion.
doctor
Answered by Dr. Michelle Gibson James 1 hour later
Brief Answer:
they would monitor his levels

Detailed Answer:
HI

There are no particular foods that would be helpful but if he is eating well then he is recovering.
Return of appetite is a good sign

You stated that he was recently given a transfusion, his doctors would monitor his platelet levels to see if they are maintained
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Michelle Gibson James 8 hours later
hi doc, sorry for askin too many questions. his doctor shows up once every other day. she would only call the nurses and tell them what to do.

is it possible for my brother's platelets to never go up? im so scared of losing him. i feel like they are not doing their job.

thank you doctor
doctor
Answered by Dr. Michelle Gibson James 3 hours later
Brief Answer:
may need to consider speaking to one of her seniors

Detailed Answer:
HI

It's fine, it is understandable to be concerned.

The levels usually respond in most persons and should with him.

Most doctors have XXXXXXX doctors in charge of them. If you are not satisfied then you can consider speaking to one of the XXXXXXX XXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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