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t h
A n n u a l C o n g r e s s o n
Nursing & Healthcare
December 03-04 , 2018
Amsterdam, Nether l ands
Journal of Nursing and Health Studies
ISSN: 2574-2825
Nursing & Healthcare 2018
D
engue fever (DF) and dengue hemorrhagic fever (DHF) are the main clinical types of dengue infection. DF runs a benign course while
DHF potentially can cause dengue shock and death. Presence of a critical phase with the pathological hallmark of plasma leakage in
DHF is the fundamental difference between DF and DHF. Reduction of mortality in DHF resides in the early diagnosis of dengue infection,
early detection of plasma leakage and accurate fluid management during the critical phase designed to prevent both shock and fluid
overload. Given the predictable stereotyped course of DHF with a febrile phase lasting 4-7 days, a critical phase lasting only 48 hours and
transition to convalescence around the 7
th
day of illness provides a window of opportunity for optimal fluid therapy to reduce mortality.
Plasma leakage commences from 3
rd
to 5
th
day of the illness. Hence, it is essential to diagnose dengue infection within the first three
days; blanching erythema been useful sign. Monitoring of physiological parameters compensating for volume depletion in the face of
plasma leakage permits early detection of plasma leakage. Severe vomiting, abdominal pain and tender hepatomegaly portend the
advent of plasma leakage which should be confirmed early by ultrasonography before clinical evidence of ascites and pleural effusion.
A calculated fluid quota of M+5% is administered over the 48 hour period of the critical phase. Fluid infusion should match the dynamics
of plasma leakage enabled by hourly monitoring of pulse rate, pulse pressure, urine output, and hematocrit. Too much of fluid in the
setting of leaky capillaries will result in fluid overload while too little results in shock and consequently fatal hemorrhages and organ
failure triggered by tissue hypoxia. Striking the right balance in fluid therapy is the art mastered by good understanding of the disease
course and application of basic cardiac physiology. I shall share the details of this art based on experience in treating over 4000 dengue
patients with only one death during the guest lecture.
kolithah@gmail.comStrategy to reduce mortality in dengue
hemorrhagic fever
Kolitha H Sellahewa
SAITM, Sri Lanka
J Nurs Health Stud 2018, Volume: 3
DOI: 10.21767/2574-2825-C5-015