Severe Dengue with Decompensated (Profound) Shock and Mean Arterial Pressure Below 65 mmHg
This protocol targets a time-critical presentation: severe dengue that has progressed to decompensated shock, with hypotension, signs of critically reduced tissue perfusion, mean arterial pressure below 65 mmHg, pulse pressure below 10 mmHg, and a raised haematocrit.
Clinical scenario
The patient has severe dengue with haemodynamic collapse. Key findings are mean arterial pressure below 65 mmHg, pulse pressure below 10 mmHg, signs of reduced perfusion, and a raised haematocrit — consistent with decompensated dengue shock requiring immediate structured intervention.
Management approach (partial overview)
The immediate step involves measuring haematocrit and preparing for blood cross-match, followed by urgent intravenous — or intraosseous — crystalloid resuscitation given as a rapid bolus. Fluid delivery is then adjusted stepwise according to the clinical response. The full sequence, volumes, monitoring criteria, and dose-adjustment schedule are available in the complete protocol.
Treatment goals
Restoration of blood pressure and clinical improvement: improved blood pressure and pulse pressure, decreased haematocrit, improved urine output, improved capillary refilling time, and normalised pulse rate.
References
- Decompensated shock among adults (hypotension + signs of reduced perfusion) mean arterial pressure (MAP) < 65, HCT high
- Table 9. Treatment of profound shock (hypotensive; undetectable pulse and BP)
- Intravenous 10–20 mL/kg of bolus fluid should be given as fast as possible, ideally within 10–15 minutes.
- Measure HCT 1 then Ringer lactate or Crystalloid (if pulse pressure < 10 mmHg or severe hypotension) IV or IO: Children and adults: 20 mL/kg in 15–30 min (1st bolus)
- Start isotonic crystalloid 10–20 mL/kg for 20–30 min as bolus
- 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
- Improvement BP improved, pulse pressure improved, HCT decreased, urine output improved, capillary refilling time improved, pulse rate normal
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