Podcast
Questions and Answers
What clinical issue is most commonly associated with the critical stage of dengue?
What clinical issue is most commonly associated with the critical stage of dengue?
- Fatigue
- Dehydration
- Shock/bleeding (correct)
- Fever resolution
How long does the febrile phase of dengue typically last?
How long does the febrile phase of dengue typically last?
- 1-3 days
- 7-14 days
- 5-10 days
- 2-7 days (correct)
What is a key laboratory finding during the critical period of dengue?
What is a key laboratory finding during the critical period of dengue?
- Increase in white blood cell count
- Decrease in white blood cell count
- Increase in platelet count
- Decrease in platelet count (correct)
What generally follows defervescence during the clinical course of dengue?
What generally follows defervescence during the clinical course of dengue?
What is the primary purpose of the tourniquet test in suspected dengue cases?
What is the primary purpose of the tourniquet test in suspected dengue cases?
Which parameter rises and indicates severity of plasma leakage during the critical phase?
Which parameter rises and indicates severity of plasma leakage during the critical phase?
How long does the clinically significant plasma leakage typically last during the critical stage?
How long does the clinically significant plasma leakage typically last during the critical stage?
In the context of dengue, what does a rising hematocrit level indicate?
In the context of dengue, what does a rising hematocrit level indicate?
Which of the following symptoms indicates a need for hospital admission in dengue patients?
Which of the following symptoms indicates a need for hospital admission in dengue patients?
What laboratory finding suggests increased risk of mortality in dengue patients?
What laboratory finding suggests increased risk of mortality in dengue patients?
Which factor is NOT considered a risk factor associated with mortality in dengue?
Which factor is NOT considered a risk factor associated with mortality in dengue?
What type of fluid is appropriate for maintenance in dengue patients without shock?
What type of fluid is appropriate for maintenance in dengue patients without shock?
What symptom is associated with significant bleeding in patients admitted due to dengue?
What symptom is associated with significant bleeding in patients admitted due to dengue?
Which of the following transfusions may be considered for children exhibiting signs of DIC related to dengue?
Which of the following transfusions may be considered for children exhibiting signs of DIC related to dengue?
Which of the following laboratory tests is NOT recommended as routine for dengue patients?
Which of the following laboratory tests is NOT recommended as routine for dengue patients?
What can be inferred about citronella-based repellents in comparison to DEET-based repellents in dengue prevention?
What can be inferred about citronella-based repellents in comparison to DEET-based repellents in dengue prevention?
What is a common complication associated with the critical stage of dengue?
What is a common complication associated with the critical stage of dengue?
During which stage of dengue may the AST or ALT levels reach ≥1000?
During which stage of dengue may the AST or ALT levels reach ≥1000?
What unique skin manifestation distinguishes the recovery phase of dengue?
What unique skin manifestation distinguishes the recovery phase of dengue?
What is the marker of acute dengue infection detectable within the first week?
What is the marker of acute dengue infection detectable within the first week?
What is the most important indicator for starting intravenous fluid therapy in dengue patients?
What is the most important indicator for starting intravenous fluid therapy in dengue patients?
What is the primary characteristic of a primary dengue infection?
What is the primary characteristic of a primary dengue infection?
Which group of patients should be managed as inpatients due to co-existing conditions?
Which group of patients should be managed as inpatients due to co-existing conditions?
Which statement about platelet transfusions in dengue management is correct?
Which statement about platelet transfusions in dengue management is correct?
What happens to pulse pressure during early shock in dengue?
What happens to pulse pressure during early shock in dengue?
What type of fluid is contraindicated for maintenance in dengue management?
What type of fluid is contraindicated for maintenance in dengue management?
At what stage is dengue shock syndrome (DSS) most likely to occur?
At what stage is dengue shock syndrome (DSS) most likely to occur?
Which of the following is NOT a warning sign of dengue?
Which of the following is NOT a warning sign of dengue?
Which parameter is indicative of more severe shock in adults?
Which parameter is indicative of more severe shock in adults?
During which phase of dengue do patients typically develop a high-grade fever suddenly?
During which phase of dengue do patients typically develop a high-grade fever suddenly?
Which of the following changes occurs during the critical period of dengue infection?
Which of the following changes occurs during the critical period of dengue infection?
What clinical observation should alert a physician to a high probability of dengue at the initial evaluation?
What clinical observation should alert a physician to a high probability of dengue at the initial evaluation?
What does a positive tourniquet test indicate in the context of dengue?
What does a positive tourniquet test indicate in the context of dengue?
In which period do most patients experience defervescence, indicating a decrease in fever?
In which period do most patients experience defervescence, indicating a decrease in fever?
What is the significant laboratory change related to fluid leakage observed during the critical stage?
What is the significant laboratory change related to fluid leakage observed during the critical stage?
What does the degree of hemoconcentration reflect during the critical phase of dengue?
What does the degree of hemoconcentration reflect during the critical phase of dengue?
How long is the period of clinically significant plasma leakage likely to last during the critical period?
How long is the period of clinically significant plasma leakage likely to last during the critical period?
Which of the following signs and symptoms indicate a need for admission in dengue patients?
Which of the following signs and symptoms indicate a need for admission in dengue patients?
What laboratory finding is indicative of increased mortality risk in dengue patients?
What laboratory finding is indicative of increased mortality risk in dengue patients?
Which of the following is considered a risk factor associated with mortality in dengue?
Which of the following is considered a risk factor associated with mortality in dengue?
What is the recommended fluid type for maintenance in dengue patients without shock?
What is the recommended fluid type for maintenance in dengue patients without shock?
Which symptom is NOT associated with significant bleeding in dengue patients?
Which symptom is NOT associated with significant bleeding in dengue patients?
What condition warrants consideration of plasma transfusion in children with dengue?
What condition warrants consideration of plasma transfusion in children with dengue?
Which factor is NOT linked to an increased risk for mortality in patients with dengue?
Which factor is NOT linked to an increased risk for mortality in patients with dengue?
Which statement about citronella-based repellents in relation to dengue is accurate?
Which statement about citronella-based repellents in relation to dengue is accurate?
What physiological response occurs during the initial stage of shock?
What physiological response occurs during the initial stage of shock?
What is observed in patients during the recovery phase of dengue?
What is observed in patients during the recovery phase of dengue?
What indicates the presence of dengue shock syndrome (DSS)?
What indicates the presence of dengue shock syndrome (DSS)?
Which statement concerning fluid management in dengue is true?
Which statement concerning fluid management in dengue is true?
In which situation is hospitalization for dengue management warranted?
In which situation is hospitalization for dengue management warranted?
What is indicated by an AST or ALT level greater than or equal to 1000?
What is indicated by an AST or ALT level greater than or equal to 1000?
What distinguishes dengue from chikungunya in clinical manifestations?
What distinguishes dengue from chikungunya in clinical manifestations?
How does the pulse pressure change during early shock in dengue?
How does the pulse pressure change during early shock in dengue?
What is the primary characteristic of a secondary dengue infection?
What is the primary characteristic of a secondary dengue infection?
What condition warrants the use of PRBCs or whole blood in dengue management?
What condition warrants the use of PRBCs or whole blood in dengue management?
What is the effect of excessive intravenous fluid therapy during the recovery stage?
What is the effect of excessive intravenous fluid therapy during the recovery stage?
What is the expected outcome of a narrowing pulse pressure during compensated shock?
What is the expected outcome of a narrowing pulse pressure during compensated shock?
What is commonly seen in the early stages of dengue infection?
What is commonly seen in the early stages of dengue infection?
Study Notes
Dengue Phases
- Three phases of dengue: Febrile, Critical, Recovery.
- Transition from febrile to afebrile phase coincides with onset of critical phase, known as Defervescent Stage.
- Critical stage is marked by a noticeable decrease in temperature.
- Potential clinical issues during the critical stage include shock and bleeding.
- Laboratory changes in the critical period: decrease in platelet count and increase in hematocrit.
Febrile Phase
- Patients often develop a sudden high-grade fever during this phase.
- Duration of acute febrile phase is 2-7 days.
- The earliest abnormality in full blood count is a progressive decrease in total white cell count, indicating high probability of dengue.
Critical Stage
- Progressive decrease in platelet count and increase in hematocrit occur during this period.
- Defervescence lasts typically from days 3-8 of illness.
- Clinically significant plasma leakage lasts 24-48 hours, indicated by rising hematocrit preceding changes in blood pressure and pulse volume.
- Metabolic acidosis and organ impairment may occur due to profound shock.
Recovery Phase
- Recovery phase presents with a confluent erythematous or petechial rash, described as "isles of white in the sea of red."
- Symptoms include general pruritus and stabilization or decrease in hematocrit due to fluid reabsorption.
- White blood cell count recovers before platelet count.
Medical Complications
- Febrile stage complications include dehydration and febrile seizures in young children.
- Critical stage complications involve shock from plasma leakage, severe hemorrhage, and organ impairment.
- Recovery stage may see hypervolemia if intravenous fluid therapy is excessive.
Diagnosis and Laboratory Findings
- NS1 antigen is a marker of acute dengue infection and is best requested during the febrile phase (day 1 to days 4-5 of fever).
- Development of IgM antibodies occurs with disappearance of fever and viremia.
- Primary infections feature high IgM and low IgG levels; secondary infections have low IgM and high IgG levels.
- Significant laboratory findings indicating risk for mortality include decline in Hb, thrombocytopenia, hemoconcentration, and elevated AST.
Management and Treatment
- Corticosteroids are not indicated for dengue management due to associated risks.
- Platelet transfusions for low platelet counts are not beneficial and may lead to complications.
- Fluid management for patients includes isotonic solutions; Group B patients should receive 0.9% saline or Ringer's lactate.
- IV fluids should be initiated based on hematocrit findings, starting with 5-7 ml/kg/hour.
- Patients with high-risk factors (age, comorbidities) should be monitored closely and may require hospitalization.
Indicators of Severity
- Warning signs of dengue include abdominal tenderness, mucosal bleeding, vomiting, enlarged liver, clinical fluid accumulation, lethargy, and increase in hematocrit.
- Risk factors associated with mortality include hypotension, narrow pulse pressure, severe dengue stages, and significant bleeding.
- Early signs of shock include tachycardia, narrowed pulse pressure, and delayed capillary refill.
Miscellaneous
- Citronella-based repellents have insufficient evidence to prove superior effectiveness over DEET-based repellents in dengue prevention.
Social Considerations for Admission
- Certain social circumstances, such as living alone or far from health facilities, may necessitate hospital management.
Dengue Phases
- Three phases of dengue: Febrile, Critical, Recovery.
- Transition from febrile to afebrile phase coincides with onset of critical phase, known as Defervescent Stage.
- Critical stage is marked by a noticeable decrease in temperature.
- Potential clinical issues during the critical stage include shock and bleeding.
- Laboratory changes in the critical period: decrease in platelet count and increase in hematocrit.
Febrile Phase
- Patients often develop a sudden high-grade fever during this phase.
- Duration of acute febrile phase is 2-7 days.
- The earliest abnormality in full blood count is a progressive decrease in total white cell count, indicating high probability of dengue.
Critical Stage
- Progressive decrease in platelet count and increase in hematocrit occur during this period.
- Defervescence lasts typically from days 3-8 of illness.
- Clinically significant plasma leakage lasts 24-48 hours, indicated by rising hematocrit preceding changes in blood pressure and pulse volume.
- Metabolic acidosis and organ impairment may occur due to profound shock.
Recovery Phase
- Recovery phase presents with a confluent erythematous or petechial rash, described as "isles of white in the sea of red."
- Symptoms include general pruritus and stabilization or decrease in hematocrit due to fluid reabsorption.
- White blood cell count recovers before platelet count.
Medical Complications
- Febrile stage complications include dehydration and febrile seizures in young children.
- Critical stage complications involve shock from plasma leakage, severe hemorrhage, and organ impairment.
- Recovery stage may see hypervolemia if intravenous fluid therapy is excessive.
Diagnosis and Laboratory Findings
- NS1 antigen is a marker of acute dengue infection and is best requested during the febrile phase (day 1 to days 4-5 of fever).
- Development of IgM antibodies occurs with disappearance of fever and viremia.
- Primary infections feature high IgM and low IgG levels; secondary infections have low IgM and high IgG levels.
- Significant laboratory findings indicating risk for mortality include decline in Hb, thrombocytopenia, hemoconcentration, and elevated AST.
Management and Treatment
- Corticosteroids are not indicated for dengue management due to associated risks.
- Platelet transfusions for low platelet counts are not beneficial and may lead to complications.
- Fluid management for patients includes isotonic solutions; Group B patients should receive 0.9% saline or Ringer's lactate.
- IV fluids should be initiated based on hematocrit findings, starting with 5-7 ml/kg/hour.
- Patients with high-risk factors (age, comorbidities) should be monitored closely and may require hospitalization.
Indicators of Severity
- Warning signs of dengue include abdominal tenderness, mucosal bleeding, vomiting, enlarged liver, clinical fluid accumulation, lethargy, and increase in hematocrit.
- Risk factors associated with mortality include hypotension, narrow pulse pressure, severe dengue stages, and significant bleeding.
- Early signs of shock include tachycardia, narrowed pulse pressure, and delayed capillary refill.
Miscellaneous
- Citronella-based repellents have insufficient evidence to prove superior effectiveness over DEET-based repellents in dengue prevention.
Social Considerations for Admission
- Certain social circumstances, such as living alone or far from health facilities, may necessitate hospital management.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on the three phases of dengue fever: febrile, critical, and recovery. This quiz covers pivotal moments in the progression of the disease, including temperature changes and laboratory findings during the critical stage.
