Dengue Fever

Dengue may become life-threatening just as the fever subsides. The central bedside problem is capillary leak: plasma moves out of the vascular space into tissues and serous cavities, reducing effective circulating volume. At the same time, thrombocytopenia and coagulopathy increase the chance that even minor bleeding will become clinically significant. Classify the illness as dengue without warning signs, dengue with warning signs, or severe dengue. Severe abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, altered mental status, hepatomegaly, or a rising hematocrit signals a need for inpatient care. Shock, respiratory compromise from fluid accumulation, severe bleeding, or severe organ impairment requires emergency treatment. The highest-risk period is usually illness days 3–7, particularly around defervescence. Pair the patient's appearance and perfusion findings with trends in pulse pressure, urine output, mental status, hematocrit, and platelet count. Replace circulating volume with isotonic crystalloid when indicated, but reassess frequently: continuing aggressive fluid therapy after plasma leakage resolves can cause dangerous fluid overload during recovery. Acetaminophen is used for fever and pain; aspirin, other NSAIDs, and routine systemic corticosteroids should be avoided.