Dengue Fever

Dengue is a mosquito-borne infection with a deceptively shifting risk profile. A patient may look better as the temperature falls, yet the transition into defervescence—usually illness days 3–7—can be when vascular permeability increases, plasma leaves the circulation, hematocrit rises, and perfusion deteriorates. A falling fever is therefore not a discharge signal; interpret it alongside pulse pressure, urine output, mental status, bleeding, and paired blood counts. In Canada, dengue is often considered after travel or residence in an endemic area. Ask about that exposure, the timing of fever, and whether this may be a previous dengue infection. Within the RPN role, follow the prescriber’s orders, local protocol, and escalation pathway while supporting serial assessment, fluid balance, medication safety, and timely reporting of deterioration. The management decision changes with the phase and severity of illness. Patients without warning signs may need oral rehydration and outpatient follow-up. Warning signs require inpatient assessment, and shock requires rapid isotonic crystalloid, continuous reassessment, and early escalation when perfusion does not respond.