Dengue Fluid Management

Initial Assessment and Risk Stratification

The American College of Physicians recommends monitoring for shock indicators, such as tachycardia, hypotension, poor capillary refill, altered mental status, cold extremities, and narrow pulse pressure, in patients with dengue fever 1, 2
The World Health Organization suggests tracking warning signs of progression, including persistent vomiting, severe abdominal pain, lethargy/restlessness, mucosal bleeding, and rising hematocrit with rapidly falling platelet count, in patients with dengue fever 1, 3

The American Academy of Pediatrics recommends targeting approximately 2,500-3,000 mL daily oral intake, which evidence shows reduces hospitalization rates, in patients with non-shock dengue 1
The Centers for Disease Control and Prevention suggest using any locally available fluids, including water, oral rehydration solutions, cereal-based gruels, soup, and rice water, and avoiding soft drinks due to high osmolality, in patients with non-shock dengue 1

The American College of Emergency Physicians recommends administering 20 mL/kg of isotonic crystalloid as a rapid bolus over 5-10 minutes, with immediate reassessment after each bolus, in patients with dengue shock syndrome 1
The Society of Critical Care Medicine suggests repeating crystalloid boluses up to 40-60 mL/kg in the first hour if shock persists after initial bolus, in patients with dengue shock syndrome 1

The American Heart Association recommends targeting endpoints, such as normal capillary refill time, absence of skin mottling, warm and dry extremities, well-felt peripheral pulses, return to baseline mental status, and adequate urine output, in patients with dengue fever 1, 2
The National Institutes of Health suggest monitoring hematocrit closely, as rising hematocrit indicates ongoing plasma leakage and need for continued resuscitation, in patients with dengue fever 3

The American College of Cardiology recommends switching from fluids to inotropic support rather than continuing aggressive fluid administration if shock persists despite adequate fluid resuscitation, in patients with dengue shock syndrome 1
The European Society of Intensive Care Medicine suggests titrating epinephrine as first-line vasopressor for cold shock with hypotension, and norepinephrine as first-line vasopressor for warm shock with hypotension, in patients with dengue shock syndrome 1

The World Health Organization recommends using acetaminophen only for pain and fever management, in patients with dengue fever 1, 3
The American Association of Blood Banks suggests maintaining hemoglobin at a minimum of 10 g/dL, as oxygen delivery depends on hemoglobin concentration, in patients with significant bleeding 4