Severe dengue shock — DTM&H MCQ

Correct answer: D — Judicious isotonic crystalloid bolus with frequent reassessment

The correct answer is D, judicious isotonic crystalloid bolus with frequent reassessment. Restlessness, cold extremities and a narrowing pulse pressure with a rising haematocrit are the classic warning signs of dengue shock syndrome, reflecting critical plasma leakage from increased capillary permeability rather than blood loss. Normal saturations exclude a primary respiratory cause and confirm this is a circulatory (leak) crisis. WHO/DTMH teaching mandates immediate isotonic crystalloid (e.g. 0.9% saline or Hartmann's) as a bolus, with meticulous reassessment of pulse, blood pressure, capillary refill and haematocrit to titrate further boluses, because both under-resuscitation (progressive shock) and over-resuscitation (fluid overload once leakage resolves) are dangerous in this narrow therapeutic window. Why the other options are wrong: B. Large-volume hypotonic saline infusion: hypotonic fluid does not restore intravascular volume as effectively as isotonic crystalloid and worsens tissue oedema; large volumes also risk precipitating fluid overload once the leak phase resolves. E. Immediate platelet transfusion as first treatment: thrombocytopenia is common in dengue but is not the cause of shock here; platelets are reserved for significant clinically evident bleeding, not for correcting haemodynamic collapse from plasma leakage. C. High-dose aspirin for capillary leakage: aspirin and other NSAIDs are contraindicated in dengue because they inhibit platelet function and increase bleeding risk in a patient already thrombocytopenic and coagulopathy-prone; they have no role in reversing capillary leak. A. Delayed fluids until bleeding occurs: withholding resuscitation is dangerous; the shock is already present (narrow pulse pressure, rising haematocrit, cold peripheries) and delay allows progression to irreversible shock and end-organ damage. Key point: narrow pulse pressure with a rising haematocrit signals dengue shock from plasma leakage, treated with prompt but carefully titrated isotonic crystalloid, avoiding both under- and over-resuscitation.

Reference: WHO, Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever (SEARO), Section on Dengue Shock Syndrome management: isotonic crystalloid resuscitation with frequent haemodynamic and haematocrit reassessment. https://ncvbdc.mohfw.gov.in/WriteReadData/l892s/guidelines%20for%20treatment%20of%20Dengue.pdf