This protocol addresses the patient with severe dengue and compensated shock — systolic pressure maintained but with clear signs of reduced tissue perfusion — in whom the first-line resuscitation bolus has not produced the expected clinical response within the first hour.

Previous Line Did Not Achieve the Required Improvement

An initial isotonic crystalloid bolus — the first-line treatment for Group C severe dengue with compensated shock — was administered, but clinical improvement after the first hour was not achieved. The goals that remained unmet: blood pressure improved, pulse pressure improved, haematocrit decreased, urine output improved, capillary refilling time improved, and pulse rate normal. This protocol defines the next step following that failure.

Treatment Approach (Partial Overview)

The approach is guided by haematocrit reassessment, which determines whether further intravenous fluid support or blood product administration is indicated — the complete selection criteria, sequencing, and decision algorithm are available in the full protocol.

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

(1st bolus over 15–30 min) crystalloid or colloid 10–15 mL/kg If no improvement, give 2nd bolus

Reduce IV crystalloids 7–10 mL/kg/h for 1–2 h

Blood transfusion/packed RBC

Colloid 10 mL/kg/h for 1 h

Improvement BP improved, pulse pressure improved, HCT decreased, urine output improved, capillary refilling time improved, pulse rate normal

View source ↗

Severe Dengue with Compensated Shock: Next Step When the First Fluid Bolus Does Not Achieve Improvement

References