Dengue taking its toll =============== Fifteen dengue patients in the ward and 2 deaths in ICU in my hospital, one of them being a surgeon, our own colleague, within a period of 24 hours has shaken all of us. These numbers only serve to reemphasize that dengue fever cannot be and should not be taken lightly. It may not be easy for hospitals to manage a large number of patients who get admitted in a day, especially when all of them require intensive rehydration therapy with IV fluids. The cause of death in both the cases was multiorgan failure, which in any case has a very high mortality. Multiple organ failure invariably occurs after there is plasma leakage, which leads to intravascular dehydration. The only strategy to reduce mortality is to prevent intravascular dehydration and following is my approach: Do not bother about transfusing platelets as platelet deficiency is not the cause of multiorgan failure. However, a rapid fall of platelets is a warning sign of impending severe dengue. If the patient has a PCV of more than 50 or the pulse pressure is less than 20, the patient is in a state of impending shock and needs rapid intravenous fluid resuscitation, which may mean up to 2 liters of fluid in the first hour. When the volume of patient is large it is impossible to manage pulse pressure, PCV and rapid fall in platelets in all the patients. My formula is: Let the patient be given IV plus oral fluids to such an extent that he passes urine every 3 hours as the first sign of intravascular dehydration will be reduction in urination output. I have found that this works. I only ask my patients to continue taking fluids, especially lemon water with salt and sugar till they pass urine and then to continue fluids so that they pass urine every 3 hours. The critical period is when fever is settling down and a period of 24 to 48 hour after the fever has subsided.
Posted on: Thu, 12 Sep 2013 15:08:22 +0000
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