Dengue with warning signs — DTM&H MCQ

Correct answer: B — Admit for careful isotonic fluid management and monitoring

The correct answer is B, admit for careful isotonic fluid management and monitoring. This patient has dengue with warning signs (abdominal pain, persistent vomiting, postural dizziness) plus laboratory evidence of plasma leakage (haematocrit rise from 38% to 47%, roughly a 24% increase, alongside thrombocytopenia). Per WHO dengue case classification, this combination mandates hospital admission for close monitoring and isotonic crystalloid fluid therapy (0.9% saline or Ringer's lactate), titrated against serial haematocrit, vital signs and urine output, since plasma leakage rather than the platelet count itself drives clinical deterioration and risk of dengue shock syndrome. Why the other options are wrong: E. Discharge with ibuprofen and oral fluids: NSAIDs are contraindicated in dengue because they worsen bleeding risk and gastric mucosal injury in a patient already thrombocytopenic; warning signs also preclude outpatient management. D. Give prophylactic platelet transfusion because platelets are low: Thrombocytopenia alone, without significant bleeding, is not an indication for transfusion; it does not address the underlying plasma leakage and carries transfusion-related risks with no proven mortality benefit. A. Start high-dose corticosteroids: Steroids have no evidence base in dengue management and do not alter capillary leak or disease course; they are not recommended by WHO guidance. C. Give broad-spectrum antibiotics as definitive dengue therapy: Dengue is a viral infection; there is no bacterial target, and antibiotics do not treat plasma leakage or thrombocytopenia. Key point: In dengue, a rising haematocrit with warning signs signals plasma leakage and mandates admission for isotonic fluid resuscitation and monitoring, not transfusion based on platelet count alone.

Reference: World Health Organization, Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control (New Edition), Geneva: WHO; Clinical Management and Delivery of Clinical Services section on fluid management for dengue with warning signs, https://www.ncbi.nlm.nih.gov/books/NBK143161/