Dengue shock syndrome — DTM&H MCQ

Correct answer: E — IV crystalloid bolus 10 mL/kg over 1 hour with haematocrit monitoring

The correct answer is E, IV crystalloid bolus 10 mL/kg over 1 hour with haematocrit monitoring. This child has dengue with warning signs progressing to early (compensated) dengue shock syndrome: abdominal pain, restlessness, narrowing pulse pressure, and a rising haematocrit (38% to 46%, a greater than 20% rise) all indicate plasma leakage and impending shock. WHO guidance, used as the basis for UK tropical medicine practice, mandates immediate isotonic crystalloid resuscitation at 10 mL/kg over one hour with serial haematocrit and vital sign reassessment to titrate further fluid, since capillary leak is transient (24 to 48 hours) and over-resuscitation risks fluid overload and pleural effusion or ascites. Colloids and larger volumes are reserved for those who fail to respond to initial crystalloid. Why the other options are wrong: C. Oral isotonic fluids at increased rate: once warning signs and shock physiology (narrowing pulse pressure, haemoconcentration) are present, oral rehydration is inadequate; the child needs IV access and monitored resuscitation, not oral fluids. D. IV colloid bolus 20 mL/kg over 30 minutes: colloid is only indicated for refractory shock after failed crystalloid boluses, and this volume/rate is excessive as first-line therapy, risking overcorrection. A. Immediate platelet transfusion: thrombocytopenia in dengue is common but prophylactic platelet transfusion does not correct the underlying plasma leakage and is not indicated without significant bleeding. B. IV dexamethasone: corticosteroids have no proven benefit in dengue shock syndrome and are not part of recommended management. Key point: A rising haematocrit with narrowing pulse pressure signals compensated dengue shock, requiring immediate crystalloid 10 mL/kg over 1 hour with haematocrit-guided titration, not colloid, platelets, or steroids.

Reference: World Health Organization, Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control, 2009 (fluid management of dengue with warning signs/shock, crystalloid 10 mL/kg over 1 hour with haematocrit monitoring): https://www.ncbi.nlm.nih.gov/books/NBK143161/