علاج حمى الضنك الشديدة مع إصابة الجهاز العصبي المركزي والاعتلال الدماغي (تشنجات / غيبوبة)

References

• Some severe dengue patients present unusual manifestations with signs and symptoms of central nervous system (CNS) involvement, such as convulsion and/or coma.
• Most of the patients with encephalopathy report hepatic encephalopathy.
• Maintain adequate airway oxygenation with oxygen therapy.
• Give minimal IV fluid to maintain adequate intravascular volume; ideally the total IV fluid should not be > 80% fluid maintenance.
• Positioning of the patient must be with the head up by 30 degrees.
• Early intubation to avoid hypercarbia and to protect the airway.
• May consider steroid to reduce ICP and dexamethasone 0.15 mg/kg/dose IV to be administered every 6–8 h.
• Give lactulose 5–10 mL every 6 h for induction of osmotic diarrhoea.
• Maintain blood sugar level at 80–100 mg/dL%. Recommend glucose infusion rate is anywhere between 4–6 mg/kg/h.
• Vitamin K1 IV administration; 3 mg for < 1-year-old, 5 mg for < 5-year-old and 10 mg for > 5-year-old and adult patients.
• Anticonvulsants should be given for control of seizures: phenobarbital, dilantin and diazepam IV as indicated.
• Transfuse blood, preferably freshly packed red cells, as indicated.
• H2-blockers or proton pump inhibitor may be given to alleviate gastrointestinal bleeding.