FEVER
Amila Weerasinghe
MBBS Undergraduate
2010/2011 Batch (21st )
Faculty of Medical Sciences
University of Sri
Jayewardenepura
Sri Lanka
19/01/2015
Contents
What is Dengue ?
2. Epidemiology
3. Vector
4. Virus
5. Pathogenesis of the disease
6. Classification
7. The natural course of the illness
8. Diagnosis and Management at OPD
level and by primary care physician.
9. In-ward Management of DF/DHF
10. Management of complicated
1.
1. What is Dengue ?
2. Epidemiology
World situation
Sri
Lankan situation
2014
46584
Cases
50000
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
http://www.epid.gov.lk
http://www.dengue.health.gov.l
k
Vector
Dengue is an interplay of
3 factors
3. Vector
4. Virus
Family Flaviviridae
Serotypes 4 serotypes
DEN 1 to 4
infection.
6. Classification
Dengue Haemorrhagic
Fever
Criteria
Febrile phase
2.
Critical phase
3.
Convalescent phase
When
to suspect
DF/DHF
fluid (maintainance)
Rest
Paracetamol
10-15mg/kg/dose
(max 60mg/kg/day)
Anti-emetics
NO
and H2 RB.
Review
of onset
Advice
review if
Clinical judgment
Febrile Phase
Febrile Phase
In DF & DHF ; lasts for 2-7 days
drops <
Platelet count
Initially normal
DHF
Tender hepatomegaly
DHF > DF
Paracetamol 10-15mg/kg/dose
(max 60mg/kg/day)
Critical Phase
Seen
only in DHF
late febrile phase;
3rd day to 7th day of illness up.
Rapid
Lasts
DHF
drop in temperature
for 24 48 hours
Identifying
48 hours
.
30
25
20
15
10
5
0
10
20
30
40
50
60
Platelets <100,000/mm3
Be Alert
of patients)
DHF
febrile phase
DHF
radiologically
Pleural
effusion
USS chest
3. Biochemical parameters
Serum albumin < 3.5g/dl or
dropped by
0.5g/dl
Serum cholesterol <100mg/dl or
dropped by
20mg/dl
( Annexure iv) in the dengue guideline - during peak of leakage & shock
IV fluids
N/2 +5% dextrose
UOP calculation
IF
UOP
UOP
Sweating
Abdominal pain
Restlessness
Signs
Cold extremities
Unexplained tachycardia
Increased DBP
After
2 crystalloid boluses;
Already
The
Clinically improvement
Diuresis
Convalescent Phase
Complications
Fluid overload
Hypocalaemia
Nosocomial infections
No other complication
Infants
Obese
Bleeding
Encephalopathy
Underline diseases
Pregnancy
organ failure
Fluid overload
Features :Early- puffy eye lids, distended
abdomen (ascites), tachypnoea,
mild dyspnoea
Late Respiratory distress, SOB, &
wheezing
ABCS
A acidosis
B Bleeding
C Calcium (hypocalcaemia)
S Sugar (hypoglycaemia)
Acidosis
Emperically
NaHCO3 1ml/kg slow bolus (max 50ml)
Bleeding
5ml/kg once
5ml/kg of PRC
HCT by 5 points
(eg:- 30 to 35)
Hypocalcaemia
Hypoglycaemia
5% Dextrose)
Add 50ml 50% Dextrose to 450ml
of 0.9% NaCl
Immediate goal
plasma glucose at least
70mg/dl
Hyponatraemia
3% NaCl is 3-5ml/kg
Slow IV
Through a larger vein; mostly a
central vein
Encephalopathy
Fluid management
Maintain MAP
Reduce ICP
Vit K IV
3mg
<1yr
5mg
1-5yrs,
10mg
>5yrs
IV Phenobarbitone - cerebral
metabolism
Controls seizures
Gut cleaning
NG tube
Antibiotics Metranidazole
Lactulose
Adjunct therapy
Platelet transfusion
Recombinant factor vii
Inotrops
Steroids & IV immunoglobulins
Fresh frozen plasma (FFP)
Frusemide
Summary
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