Categories
Paediatrics

Dengue (Paediatrics)

Last Updated on February 10, 2023

Warning signs

• Lethargy, restlessness
• Abdominal pain — abdominal tenderness & continuous pain
• Clinical fluid accumulation — pleural effusion / ascites
• Liver enlargement >2 cm
Persistent vomiting
Mucosal bleed
• Laboratory findings: ↑ haematocrit with concurrent ↓ platelet

Severity of shock

Normal Circulation

Compensated Shock

Decompensated / Hypotensive Shock

Consciousness level

Clear & alert

Clear

(may be missed if you do not touch patient)

Change of mental state - restless / drowsy

Temperature of extremities

Warm & pink

Cold

Cold clammy extremities

Capillary refill time (CRT)

Brisk (<2 seconds)

Prolonged (>2 seconds)

Mottled skin, very prolonged CRT

Peripheral pulse volume

Good volume

Weak & thready pulses

Feeble / Absent

Heart rate

Normal

Tachycardia

Severe tachycardia // bradycardia in late shock

Blood pressure

Normal

- Normal SBP with rising DBP

- Postural hypotension

Hypotension / Unrecordable BP

Pulse pressure

Normal

Narrowing pulse pressure

Narrowed (≤20 mmHg) / Unrecordable

Respiratory rate

Normal

Tachypnoea

Metabolic acidosis / Hypernoea

Urine output

Normal

Reducing trend

Oliguria / Anuria

CPG

CPG Management of Dengue in Children (2nd ed, 2020)

Take Home Message

1. Child must be touch touched, or else parameters of shock will be missed e.g. cold extremities, weak peripheral pulses, prolonged CRT

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