Treatment Guidelines for Dengue and Dengue Hemorrhagic Fever - Flowchart
Treatment Guidelines for Dengue and Dengue Hemorrhagic Fever - Flowchart Dengue Fever Dengue Fever
«Flowchart»

Start

Start

Start

A

A

A

B

B

B

Check HCT

Check HCT

Check HCT

Check HCT

IV crystalloid 5-7 ml/kg/h for 1-2 hours, then:


Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.

If patient continues to improve, fluid can be further reduced.

Monitor HCT 6-8 hourly.

If the patient is not stable, act according to HCT levels:


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.

Stop at 48 hours.

IV crystalloid 5-7 ml/kg/h for 1-2 hours, then:


Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.

If patient continues to improve, fluid can be further reduced.

Monitor HCT 6-8 hourly.

If the patient is not stable, act according to HCT levels:


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.

Stop at 48 hours.

IV crystalloid 5-7 ml/kg/h for 1-2 hours, then:


Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.


Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.

If patient continues to improve, fluid can be further reduced.

Monitor HCT 6-8 hourly.

If the patient is not stable, act according to HCT levels:


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.

Stop at 48 hours.

Improvement

Improvement

Improvement

Improvement

Yes

Yes

Yes

No

No

No

End

End

End

Administer 2nd bolus of fluid 10-20 ml/kg/h for 1 hour

Administer 2nd bolus of fluid 10-20 ml/kg/h for 1 hour

Administer 2nd bolus of fluid 10-20 ml/kg/h for 1 hour

Administer 2nd bolus of fluid

Consider significant occult/overt bleed
Initiate transfusion with fresh whole blood

Consider significant occult/overt bleed
Initiate transfusion with fresh whole blood

Consider significant occult/overt bleed
Initiate transfusion with fresh whole blood

Consider significant occult/overt bleed

HCT ↑ or high

HCT ↑ or high

↑ HCT ↑ or high ↑

HCT ↓

HCT ↓

↓ HCT ↓ ↓

If patient improves, reduce to 7-10 ml/kg/h for 1-2 hours then reduce further

If patient improves, reduce to 7-10 ml/kg/h for 1-2 hours then reduce further

If patient improves, reduce to 7-10 ml/kg/h for 1-2 hours then reduce further

Improvement

Improvement

Improvement

Improvement

Yes

Yes

Yes

No

No

No

Compensated shock (systolic pressure maintained but has signs of reduced perfusion)
Fluid resuscitation with isotonic crystalloid 5-10 ml/kg/h over 1 hour

Compensated shock (systolic pressure maintained but has signs of reduced perfusion)
Fluid resuscitation with isotonic crystalloid 5-10 ml/kg/h over 1 hour

Compensated shock (systolic pressure maintained but has signs of reduced perfusion)
Fluid resuscitation with isotonic crystalloid 5-10 ml/kg/h over 1 hour

Compensated shock (systolic pressure maintained but has signs of reduced perfusion)

Hypotensive shock
Fluid resuscitation with 20 ml/kg isotonic crystalloid or colloid over 15 min
Try to obtain a HCT level before fluid resuscitation

Hypotensive shock
Fluid resuscitation with 20 ml/kg isotonic crystalloid or colloid over 15 min
Try to obtain a HCT level before fluid resuscitation

Hypotensive shock
Fluid resuscitation with 20 ml/kg isotonic crystalloid or colloid over 15 min
Try to obtain a HCT level before fluid resuscitation

Hypotensive shock

Crystalloid/colloid 10 ml/kg/h for 1 hour, then continue with:


IV crystalloid 5-7 ml/kg/h for 1-2 hours;
Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.
If patient continues to improve, fluid can be further reduced.

Monitor HCT 6-hourly.

If the patient is not stable, act according to HCT levels:


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.

Stop at 48 hours.

Crystalloid/colloid 10 ml/kg/h for 1 hour, then continue with:


IV crystalloid 5-7 ml/kg/h for 1-2 hours;
Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.
If patient continues to improve, fluid can be further reduced.

Monitor HCT 6-hourly.

If the patient is not stable, act according to HCT levels:


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.

Stop at 48 hours.

Crystalloid/colloid 10 ml/kg/h for 1 hour, then continue with:


IV crystalloid 5-7 ml/kg/h for 1-2 hours;
Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.
If patient continues to improve, fluid can be further reduced.


IV crystalloid 5-7 ml/kg/h for 1-2 hours;
Reduce to 3-5 ml/kg/h for 2-4 hours;
Reduce to 2-3 ml/kg/h for 2-4 hours.
If patient continues to improve, fluid can be further reduced.

Monitor HCT 6-hourly.

If the patient is not stable, act according to HCT levels:


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.


If HCT increases, consider bolus fluid administration or increase fluid administration;
If HCT decreases, consider transfusion with fresh whole transfusion.

Stop at 48 hours.

Improvement

Improvement

Improvement

Improvement

Yes

Yes

Yes

No

No

No

Consider significant occult/overt bleed
Initiate transfusion with fresh whole blood

Consider significant occult/overt bleed
Initiate transfusion with fresh whole blood

Consider significant occult/overt bleed
Initiate transfusion with fresh whole blood

Consider significant occult/overt bleed

Administer 2nd bolus fluid (colloid) 10-20 ml/kg over half to 1 hour

Administer 2nd bolus fluid (colloid) 10-20 ml/kg over half to 1 hour

Administer 2nd bolus fluid (colloid) 10-20 ml/kg over half to 1 hour

Administer 2nd bolus fluid (colloid)

Review 1st HCT

Review 1st HCT

Review 1st HCT

Review 1st HCT

HCT ↑ or high

HCT ↑ or high

↑ HCT ↑ or high ↑

HCT ↓

HCT ↓

↓ HCT ↓ ↓

Repeat 2nd HCT

Repeat 2nd HCT

Repeat 2nd HCT

Repeat 2nd HCT

Improvement

Improvement

Improvement

Improvement

Yes

Yes

Yes

No

No

No

Administer 3rd bolus fluid (colloid) 10-20 ml/kg over 1 hour

Administer 3rd bolus fluid (colloid) 10-20 ml/kg over 1 hour

Administer 3rd bolus fluid (colloid) 10-20 ml/kg over 1 hour

Administer 3rd bolus fluid (colloid)

HCT ↑ or high

HCT ↑ or high

↑ HCT ↑ or high ↑

HCT ↓

HCT ↓

↓ HCT ↓ ↓

Repeat 3rd HCT

Repeat 3rd HCT

Repeat 3rd HCT

Repeat 3rd HCT

Improvement

Improvement

Improvement

Improvement

Yes

Yes

Yes

No

No

No