Malaysian 3rd Edition Dengue CPG

Malaysian 3rd Edition Dengue CPG

Download : Dengue CPG 3rd Edition 

List of Recommendations : 

Recommendation 1

♥ The baseline HCT and WCC should be established as early as possible in all patients With suspected dengue infection.
♥ Serial FBC and HCT must be monitored as the disease progresses.

Recommendation 2

♥ Dengue rapid combo test or NS1 Ag should be taken as soon as the disease is
suspected.
♥ Dengue lgM is usually positive after day 5-7 of illness. Therefore a negative IgM taken before day 5-7 of illness does not exclude dengue infection.
♥ if dengue igM is negative before day 7, a repeat sample must be taken in recovery
phase.
♥ if dengue igM is still negative after day 7, dengue IgG is recommended for diagnostic confirmation.

Recommendation 3

♥ A repeat dengue serology should be obtained at the time of death.
♥ Suitable specimens for viral isolation and/RT-PCR and] N31 antigen detection are recommended for confirmation of dengue.

Recommendation 4

♥ All patients requiring admission should be immediately started on an appropriate fiuid therapy (oral or intravenous).
♥ When indicated, intravenous fluid therapy should be initiated and adjusted accordingly,
♥ Serial monitoring of vital signs must be done and documented.
♥ Strict monitoring of ongoing fluid losses and hourly fluid input/output. i.e. “i/o" charting must be done.
♥ Patients with deteriorating vital signs must be uptriaged accordingly.

Recommendation 5

♥ In patients without co—morbidities who can tolerate orally, adequate oral fluid intake of two to three litres daily should be encouraged. This group of patients may not require intravenous fluid therapy.
♥ Intravenous fluid is indicated in patients with :-
- vomiting, unable to tolerate oral fluids or severe diarrhoea
- increasing HCT (with other signs of ongoing plasma leakage) despite increased oral intake.
- Crystalloid should be the fluid of choice for non-shock patients.

Recommendation 6
♥ Crystalloids should be the preferred choice in compensated DSS.
♥ Compensated DSS who do not respond to initial crystalloid resuscitation should receive colloids as the second fluid bolus.
♥ ln decompensated DSS, colloids should be the initial solution for resuscitation.
♥ In persistent shock, other causes of shock should be aggressively looked for

Recommendation 7
♥ Patients with mild bleeding such as from the gums or per vagina. epistaxis and
petechiae do not require blood transfusion.
♥ Transfusion with blood (preferably less than 5 days) 1 blood component is indicated in significant bleeding.

Recommendation 8

♥ Cardiac complications of dengue should be suspected in those with fluid refractory shock or haemodynamic compromise disproportionate to capillary leakage.
♥ Adequate fluid resuscitation is a pre-requisite before myocardial dysfunction can be diagnosed.

Recommendation 9

♥ In patients with altered sensorium, the common causes for encephalopathy must ruled out.
♥ in patients with suspected encephalitis, symptoms and signs suggestive of raised
intracranial pressure should be looked for

Recommendation 10

♥ Non invasive ventilation may be beneficial in those who are alert, cooperative and haemodynamically stable with or without mild metabolic acidosis.
♥ Caution should be exercised during intubation as sedatives and mechanical ventilation may worsen haemodynamic instability.
♥ Fluid therapy is the mainstay of treatment in decompensated shock, however inotrope and vasopressors may be used as a temporary measure.
♥ CVP should not be used to guide fluid therapy.
♥ Subclavian vein cannulation should be avoided.
♥ The use of real time USG is recommended for CVC insertion if it is available and there is expertise.

Recommendation 11

♥ All pregnant mothers with dengue should be managed in hospitals by physician, anaesthetist and obstetrician.
♥ Blood and blood products should be transfused as indicated when operative delivery is decided.
♥ spontaneous vaginal delivery should be the preferred mode of delivery.
♥ serology test (Dengue lgM and NS1 antigen) or RT-PCR should be performed in neonates to confirm congenital dengue.