This protocol covers severe dengue in decompensated (profound) shock — persistent hypotension with signs of reduced tissue perfusion — where an initial resuscitation bolus has not achieved haemodynamic recovery.

Clinical Scenario

Severe dengue with decompensated shock: hypotension with signs of reduced perfusion, mean arterial pressure below 65 mmHg, pulse pressure below 10 mmHg, and raised haematocrit.

Why This Protocol Applies — Prior Line Did Not Achieve Targets

An initial intravenous fluid bolus (Ringer lactate or crystalloid) was given but failed to restore the required endpoints: blood pressure, pulse pressure, haematocrit, urine output, capillary refilling time, and pulse rate did not normalise. This protocol defines the structured next step following that failure.

Treatment Approach (Partial Overview)

When the first bolus does not reverse shock, management proceeds with a repeat bolus — with fluid choice determined by the haematocrit result, and including blood product options where overt bleeding is suspected. The full decision sequence and clinical thresholds are available in the structured protocol below.

Clinical goals: Restoration of blood pressure and clinical improvement — BP improved, haematocrit decreased, urine output improved.

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)
If shock is not reversible after the first bolus, a repeat bolus and laboratory results should be pursued and corrected as soon as possible.
(2nd bolus over 15–30 min) Crystalloid or colloid 10–20 mL/kg 3rd bolus if not improved
Blood transfusion/packed RBC
Colloid 10 mL/kg/h for 1 h
Severe haemorrhage Transfuse Children and adults: Fresh whole blood 10–15 mL/kg
Improvement BP improved, pulse pressure improved, HCT decreased, urine output improved, capillary refilling time improved, pulse rate normal

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Severe Dengue with Decompensated Profound Shock: What to Do When the Initial Bolus Has Not Restored Perfusion

Clinical Scenario

Why This Protocol Applies — Prior Line Did Not Achieve Targets

Treatment Approach (Partial Overview)

References