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Infectious Disease · Ward Pathways · Locked — free with a referral
By Dr Javed Akhtar · Last reviewed 2 October 2026
Presentation Day 5 of fever (now settling); abdominal pain, repeated vomiting, gum bleeding, restless; liver 3 cm; haematocrit 48% (baseline 38%), platelets 32,000; NS1 positive
Red flags Pulse pressure ≤20 mmHg Persistent vomiting, severe abdominal pain Mucosal bleeding Lethargy/restlessness Rising haematocrit with platelets <50,000 Differential diagnosis Malaria Leptospirosis Scrub typhus Chikungunya Typhoid Sepsis / meningococcaemia When to admit, call ICU or discharge Admit: Warning signs, pregnancy, infants/elderly, comorbidities, living far from careICU: Dengue shock, severe bleeding, severe organ impairmentTransfuse: Red cells for significant bleeding or falling haematocrit with instability; platelets only for significant bleedingKey points The danger comes as the fever falls — day 3–7 — when plasma leaks. Haematocrit is the fluid compass: rising = more fluid; falling with shock = bleeding. India reports dengue nationwide each monsoon; notify every confirmed case (NCVBDC). Never Give NSAIDs, aspirin or IM injections Transfuse platelets prophylactically for a number alone Keep IV fluids running after the leak phase ends (overload) Give steroids (no benefit) Common mistakes Over- or under-fluid Prophylactic platelets NSAIDs Missing co-infections Disposition and follow-up Ward with hourly observations during the critical phase; ICU for shock. Discharge after the criteria are met.
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