Dengue: Warning Signs, Platelet Myths and When Admission Is Needed
Most dengue is managed at home with fluids and paracetamol. The danger period is not when fever is highest — it is the day the fever settles.
Read articleDengue is a viral fever spread by the day-biting Aedes mosquito, which breeds in clean stored water around the house. Most cases recover with rest and fluids, but a small proportion deteriorate suddenly around the time the fever settles.
Symptoms
Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.
- Sudden high fever with severe headache and pain behind the eyes
- Severe muscle and joint pain
- Nausea, vomiting and loss of appetite
- A rash appearing a few days into the illness
- Bleeding from the gums or nose, or easy bruising
- Extreme weakness during recovery, lasting a week or more
When to see a doctor
Do not wait these out
If any of the following applies, arrange to be seen the same day. For anything sudden or severe, call 9281862028 or come straight to the emergency department at SIMS — it is open 24 hours and does not need an appointment.
- Severe abdominal pain, persistent vomiting or bleeding — attend the emergency department
- Cold clammy hands, restlessness or a sudden drop in temperature with weakness
- Reduced urine output, giddiness on standing or drowsiness
- Fever beyond three days, which should be tested rather than treated blindly
- Never take painkillers of the NSAID class or aspirin in suspected dengue
Tests that may be advised
Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.
- Dengue NS1 antigen in the early days, and IgM antibody later
- Complete blood count with daily platelet and haematocrit monitoring
- Liver function and kidney function tests
- Ultrasound of the abdomen for fluid collections in warning-sign cases
- Tests to exclude malaria, typhoid and other causes of fever
How it is treated
Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.
- Generous oral fluids — water, ORS, coconut water, buttermilk and soups
- Paracetamol for fever, avoiding NSAIDs and aspirin entirely
- Admission with intravenous fluids and close monitoring for warning signs
- Platelet transfusion only for active bleeding or on specific medical indication, not for a number alone
- Mosquito control at home — emptying and scrubbing water containers weekly, covering tanks
This page is general information, not a diagnosis
Dengue can look like several other conditions, and the reverse is equally true. Nothing here can replace an examination, your test results and the judgement of the doctor treating you — and no medicine mentioned by name to a friend or relative should be started on the strength of this page. If you recognise yourself in it, book a consultation with the General Medicine department. If a symptom is sudden or severe, call 9281862028.
