Severe Dengue Encephalopathy: Next-Line Management When Supportive Therapy Fails to Maintain Blood Sugar Control
Clinical Scenario
Some patients with severe dengue develop central nervous system (CNS) involvement — presenting with encephalopathy, convulsion, and/or coma. This represents an unusual but serious manifestation of the disease. Most patients in this setting show features consistent with hepatic encephalopathy, compounding the clinical challenge.
When Initial Supportive Therapy Has Not Achieved Its Target
The first-line approach for dengue encephalopathy — supportive therapy to maintain the airway and reduce intracranial pressure — aims, among other goals, to keep blood sugar within a defined target range of 80–100 mg/dL. When this blood sugar target is not achieved despite initial supportive management, escalation to the next protocol level is indicated.
Next-Line Approach
In cases of ongoing clinical deterioration, certain extracorporeal or renal support strategies may be considered. The full structured protocol — including which specific modalities apply and the conditions under which they are used — is available via the link below.
References
- Some severe dengue patients present unusual manifestations with signs and symptoms of central nervous system (CNS) involvement, such as convulsion and/or coma.
- Most of the patients with encephalopathy report hepatic encephalopathy.
- Consider plasmapheresis or haemodialysis or renal replacement therapy in cases with clinical deterioration.