Brief Answer:
A possible transition to DHF. Relevant identification and safety measures provided.

Detailed Answer:
Hello, Sir.

I understand your concern.

I have carefully gone through your wife's lab parameters in detail.

She seems to show-

1.Falling platelet counts.

2.Elevated liver enzymes-SGPT/SGOT(an imminent indication of liver damage)

3.Biphasic variation in temperature.The fever can last 2-7 days.

The above factors indicate the transition of Dengue fever to Dengue hemorrhagic fever-DHF.This transition should be strongly suspected, prevented and if possible treated early.The entire crux lies only here.

Dengue runs 3 phases transiting one into the other.

Dengue fever---->DHF-------->Dengue shock syndrome.

Our motto is to identify and treat DHF as early as possible.

Hence, I would like to suggest you an investigative work up which can diagnose DHF-Changing symptoms must be identified promptly.

1.A drop in the platelet count presages the development of dengue hemorrhagic fever. The initial phase of dengue hemorrhagic fever is similar to that of dengue fever.

2.If left untreated, dengue hemorrhagic fever most likely progresses to dengue shock syndrome. Common symptoms in impending shock include abdominal pain, vomiting, and restlessness.

In patients with dengue hemorrhagic fever(defect in blood coagulation system), the following may be present.Hence, a testing for the same is indicated to identify coagulopathy.

1.Increased hematocrit level secondary to plasma extravasation and/or third-space fluid loss.---Check hematocrit

A hematocrit level increase greater than 20% is a sign of hemoconcentration and precedes shock. The hematocrit level should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever and every 3-4 hours in severe cases of dengue hemorrhagic fever or dengue shock syndrome.

2.Hypoproteinemia.---Check total protein levels

3.Prolonged prothrombin time----Check PT

4.Prolonged activated partial thromboplastin time----Check APTT.

5. Guaiac test-Signs of early coagulopathy may be as subtle as a Guaiac test that is positive for occult blood in the stool. Guaiac testing should be performed on all patients in whom dengue virus infection is suspected.

6.Check platelet count-Platelet counts less than 100,000 cells/μL are seen in dengue hemorrhagic fever or dengue shock syndrome and occur before defervescence(fever abatement) and the onset of shock. The platelet count should be monitored at least every 24 hours to facilitate early recognition of dengue hemorrhagic fever.

7a.Ultrasonography(of chest and abdomen)- is a potentially timely, cost-effective, and easily used modality in the evaluation of potential dengue hemorrhagic fever. Positive and reliable ultrasonographic findings include fluid in the chest and abdominal cavities.

7b.Plasma leakage was detected in some patients within 3 days of fever onset. Pleural effusion(fluid accumulation around the lung) was the most common sign. Based on ultrasonographic findings, dengue hemorrhagic fever was predicted in many patients even before hemoconcentration criteria had been met.

Successful management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Admission to an intensive care unit is can be a safe option in patients with established DHF.

Patients may need volume replacement.Intravascular volume deficits should be corrected with isotonic fluids such as Ringer lactate solution along with Glucose.

The addition of Human albumin infusion will be of great help in the current scenario.

Platelet and fresh frozen plasma should be kept ready for transfusions later.

Lumrax is of no use if malaria is not co-existing.


Discuss these treatment options with your Doctor.

Post your further queries if any.

Thank you.

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