Dengue: Warning Signs, Platelet Myths and When Admission Is Needed

The three phases

Dengue runs a predictable course. The febrile phase lasts two to seven days with high fever, severe headache, pain behind the eyes, muscle and joint pain and a rash. The critical phase follows as the fever falls, usually between day three and day seven — and this is when plasma leaks from blood vessels and a patient can deteriorate rapidly. The recovery phase then follows over 48 to 72 hours.

This sequence matters because families often relax when the fever settles. In dengue, the fever settling is precisely the moment to watch most carefully.

Warning signs requiring immediate hospital review

• Severe, continuous abdominal pain or tenderness
• Persistent vomiting that prevents fluid intake
• Bleeding from gums or nose, black stools, or blood in vomit
• Restlessness, irritability or sudden drowsiness
• Cold, clammy hands and feet
• Reduced urine output over six to eight hours
• Rapid breathing or abdominal swelling

The platelet myth

Platelet count is the number families fixate on, but it is not the main determinant of danger. Bleeding risk becomes significant only at very low counts, and platelet transfusion is generally reserved for counts below 10,000 or for active significant bleeding — not for a number alone.

What actually matters more is the haematocrit, which reflects plasma leakage, together with blood pressure, urine output and the warning signs above. A patient with a platelet count of 40,000 who is alert, passing urine and drinking well is in a better position than one with 90,000 who is vomiting and has cold extremities.

Papaya leaf extract, kiwi fruit and similar remedies are widely used and have no reliable evidence of changing outcomes. They are not dangerous in themselves, but relying on them instead of monitoring is.

Home care when admission is not needed

• Paracetamol only for fever and pain — strictly avoid ibuprofen, diclofenac, aspirin and other NSAIDs, which increase bleeding risk
• Fluids continuously: water, oral rehydration solution, buttermilk, coconut water, soups and rice kanji
• Complete rest, with an adult monitoring the patient at all times
• Daily blood counts as advised, and daily review during the critical phase
• Return immediately if any warning sign appears

Preventing the next case

The Aedes mosquito breeds in clean stagnant water and bites during the day, particularly early morning and late afternoon. Empty and scrub water containers, coolers, plant trays, discarded tyres and terrace debris weekly. Cover overhead and ground tanks. Use repellent and full-sleeved clothing during daylight hours.

A second dengue infection with a different serotype carries a higher risk of severe disease than the first. Anyone who has had dengue before should be particularly careful about prevention, and should seek review earlier rather than later during a subsequent fever.