This protocol applies to dengue patients classified as Group B — those with warning signs or belonging to a special high-risk population — in whom the first-line fluid approach has not produced the expected haemodynamic response within the first hour.
The patient presents with dengue with warning signs, or is part of a special/high-risk population with comorbidity. Systolic pressure is maintained, but signs of reduced perfusion are present and haematocrit is raised — indicating ongoing capillary leakage and haemodynamic compromise.
The initial approach — isotonic crystalloid at a standard rate for the first hour — did not achieve the required clinical improvement: blood pressure, pulse pressure, haematocrit, urine output, and capillary refilling all remained below target. This protocol defines the next step following that failure.
The dengue patients with warning signs and high-risk groups are considered to be as moderately ill and classified as Group B.
Includes dengue with warning signs or all special populations
Grade B with warning signs in adults (systolic pressure maintained + signs of reduced perfusion), HCT high
If the vital signs are worsening and HCT rising rapidly, increase the rate to 5–10 mL/kg/h for 1–2 h.
(1st bolus over 15–30 min) Crystalloid or colloid 10 mL/kg/h for 1 h
Reduce IV crystalloids 7–10 mL/kg/h for 1–2 h
Blood transfusion/packed RBC
Colloid 10 mL/kg/h
Improvement BP improved, pulse pressure improved, HCT decreased, urine output improved, capillary refilling
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