Dengue: When fever falls, danger can rise!
One of the most dangerous misconceptions about dengue is that once the fever disappears, the patient recovers.
Many people mistakenly believe that once a fever caused by dengue virus drops, the patient has fully recovered. However, a decline in temperature can actually mark the onset of a dangerous stage of the illness known as the critical phase. During this time, inflammation can cause tiny blood vessels to become more permeable, allowing plasma to leak from the bloodstream into surrounding tissues and organs.
This condition, plasma leakage, reduces the effective volume of blood circulating through the body, leading to more concentrated blood and potential fluid buildup around vital organs such as the lungs or abdomen.
As plasma loss intensifies, blood pressure and circulation may plummet, potentially resulting in dengue shock. Shock occurs when vital organs do not receive sufficient blood and oxygen, which can lead to organ dysfunction and, in severe cases, multi-organ failure and death. Therefore, monitoring haematocrit, or HCT, which measures the proportion of blood made up of red blood cells, is crucial in detecting plasma leakage.
A rising haematocrit, particularly when combined with clinical deterioration, may indicate significant plasma leakage even if platelet counts have not plummeted.
Platelet count alone is insufficient to gauge the severity of dengue, as patients and families often focus on this aspect. Doctors must also closely monitor blood pressure, pulse pressure, urine output, peripheral circulation, and the patient's overall clinical condition. If a patient's haematocrit rises, especially along with worsening clinical status, it may signal substantial plasma leakage despite normal platelet levels.
Fluid management is a critical component of dengue treatment, but simply providing saline is not the solution. Both under- and overhydration can pose dangers. Insufficient fluid intake can exacerbate plasma loss and trigger shock and organ injury, while excessive intravenous fluid administration can lead to fluid overload, causing pulmonary edema, breathing difficulties, or cardiac complications.
The key is providing the correct fluid type, the appropriate amount, and at the right time, with continuous reassessment of the patient's condition.
Patients who maintain adequate fluid intake through oral means may not require intravenous fluids. However, those showing warning signs or exhibiting significant plasma leakage may need carefully measured isotonic intravenous fluids, adjusted based on blood pressure, pulse, urine output, haematocrit, and clinical response. An alarming trend is the occurrence of severe dengue illness shortly after the fever subsides, sometimes even after a patient appears well enough to be discharged from the hospital.
This is not typically a recurrence of dengue; rather, the critical phase often initiates during defervescence, lasting approximately 24 to 48 hours. Severe abdominal pain, persistent vomiting, unusual drowsiness or restlessness, cold extremities, breathing difficulties, bleeding, dizziness, or reduced urine output after the fever ends should prompt immediate medical evaluation.
Understanding the risks associated with plasma leakage and managing fluids appropriately during this critical window can determine whether a patient recovers without complications or faces life-threatening shock.
Written by urgent.news from Daily Star BD Health's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
This story
This is one outlet's version. Read the fullest account.
