Treatment of Dengue Fever with Compensated Shock and Pulse Pressure Below 20 mmHg
Severe dengue can progress to circulatory compromise before systolic pressure falls. This protocol addresses the earliest, most time-sensitive stage: systolic pressure is still maintained, yet perfusion is already impaired — a state that demands immediate, structured intervention.
Clinical Scenario
- Severe dengue with plasma leakage and haemodynamic compromise
- Compensated shock: systolic pressure maintained with signs of reduced perfusion
- Pulse pressure below 20 mmHg
- Raised haematocrit
Treatment Approach
Management centres on prompt intravenous volume restoration using an isotonic crystalloid solution, administered as a structured initial bolus and then systematically reduced in rate as perfusion recovers. Initial laboratory preparation — including haematocrit measurement and blood group determination — is part of the protocol's opening steps.
The complete sequence, titration schedule, decision points, and paediatric versus adult considerations are available in the full structured protocol.
Treatment Targets (After First Hour)
- Blood pressure improved
- Pulse pressure improved (above 20 mmHg)
- Haematocrit decreased
- Urine output improved
- Capillary refilling time improved
- Pulse rate normalised
References
- Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress
- Compensated shock (systolic pressure maintained + signs of reduced perfusion) pulse pressure < 20 mmHg, HCT high
- Start isotonic crystalloid 10-15 mL/kg/h for 1 h
- Measure HCT 1 then give Ringer lactate (1st bolus) Children: 10–20 mL/kg in 15–30 min Adults: 5–10 mL/kg in 15–30 min
- IV crystalloid, reduce gradually 5–7 mL/kg/h for 1–2 h, 3–5 mL/kg/h for 2–4 h, 2–3 mL/kg/h for 2–4 h
- It is essential that the rate of IV fluid be reduced as peripheral perfusion improves; but it must be continued for a minimum duration of 24 h and discontinued by 36–48 h.
- Stop IV fluids at 24–48 h
- Improvement: BP improved, pulse pressure improved, HCT decreased, urine output improved, capillary refilling time improved, pulse rate normal
View source ↗