Dengue fever
ICD-10 A97; A90; A91 · ICD-11 1D2Z

Treatment of Dengue Fever with Fluid Overload, Ascites, and Pulmonary Oedema

Fluid overload is the most common serious complication of dengue fever. As overload advances, it can progress to frank pulmonary oedema and respiratory distress — a time-critical clinical situation requiring a structured management approach guided by haemodynamic status.

Clinical scenario

Early warning signs of fluid overload in dengue include puffy eyelids and distended abdomen (ascites). As the condition worsens, tachypnoea and dyspnoea develop, with risk of progression to pulmonary oedema and acute respiratory distress.

Management approach — partial overview

The protocol differentiates between patients who are haemodynamically stable and those in shock when fluid overload is present, applying distinct sequences in each case. It also specifies an escalation path when initial diuretic therapy does not produce an adequate response, and addresses the role of procedural intervention in severe respiratory compromise.

Treatment goal: Reduction of haematocrit to baseline or below, with restoration of adequate urine output.

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References

  1. The most common complication is fluid overload.
  2. Early signs and symptoms include puffy eyelids, distended abdomen (ascites), tachypnoea, and mild dyspnoea.
  3. In the late stage of fluid overload or those with frank pulmonary oedema, furosemide may be administered if the patient has stable vital signs. If they are in shock, together with fluid overload 10 mL/kg/h of colloid (dextran) should be given. When the blood pressure is stable, usually within 10–30 min of infusion, administer IV 1 mg/kg/dose of furosemide and continue with dextran infusion until completion. IV fluid should be reduced to as low as 1 mL/kg/h until discontinuation when haematocrit decreases to baseline or below (with clinical improvement).
  4. In cases with no response to furosemide (no urine obtained), repeated doses of furosemide and doubling of the dose are recommended. If oliguric renal failure is established, renal replacement therapy is to be done as soon as possible.
  5. Pleural and/or abdominal tapping may be indicated and can be life-saving in cases with severe respiratory distress and failure of the above management.
  6. IV fluid should be reduced to as low as 1 mL/kg/h until discontinuation when haematocrit decreases to baseline or below (with clinical improvement).
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