CARE FOR DENGUE PATIENT

DENGUE HEMORRHAGIC FEVER

Dengue Hemorrhagic Fever (DHF) is a viral infection characterized by a high fever in the first 2 to 3 days and is usually accompanied by gastritis, severe headache, and nausea and vomiting. This is followed by a drop on the platelet and WBC count, high lymphocytes differential and hemorrhagic manifestations entering the toxic stage that usually starts on the 3rd or 4th day of the ailment and has duration of about 3 days.

The toxic stage naturally commences with a sudden drop of fever - something that gives a false sense of security as a patient may look to have recovered from fever. Care for the patient should be continued as fever of a DHF patient simply goes into remission at the start of the toxic stage. It is during this stage that hemorrhagic bleeding can occur if proper care is inadequate. Clinically, the toxic stage is the period when the smallest blood vessels, the capillaries become excessively permeable and leaky, allowing the fluid component to escape from the blood vessels into the peritoneum or pleural cavity that can either lead to ascites or pleural effusions. This can result to failure of the circulatory system and shock, and possibly death without prompt and appropriate treatment.

Treatment

There is no specific medication for treatment of a dengue infection. Patient who suffers high fever and is suspected to be suffering from dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing ibuprofen, naproxen, aspirin or aspirin containing drugs (These drugs thin the blood and can encourage and aggravate hemorrhagic bleeding). Patient should also rest, drink plenty of fluids to prevent dehydration and avoid mosquito bites while febrile since it is during this time that mosquito can pick up the virus and pass it to a new host.

If a clinical diagnosis is made early, a health care provider can effectively treat DHF using fluid replacement therapy. Adequate management of DHF generally requires hospitalization.

Mitigating the DHF (Altenative and Modern Outlook)

o Tawa-tawa Tea or Camote tops tea at the onset of fever – Tawa-tawa and Camote tops are traditionally known to raise platelet count; hence, it would be wise to immediately give the patient tea made of either Tawa-tawa or Camote tops at the onset of fever. This is to avoid the platelet from going down to an alarming low count should the fever is indeed due to DHF.

o Frequent but moderate fluid intake – (Tawa-tawa or Camote tops tea should serve as the patient’s water) Fluid intake is necessary to avoid complication, however, since dizziness and vomiting usually accompany high fever it is advisable to give the patient fluid frequently but in moderate amount to avoid inducing vomit reflex.

o Lugaw diet and Rest – Hemorrhagic bleeding is one dreaded complication that ought to be avoided from happening to a dengue patient, hence acidic foods and drinks or anything that induces secretion of acidic enzymes such as protein and fats should be eliminated from the diet. Fruits and anything raw have enzymes in them and therefore should also be eliminated from the diet. Reason: Acidic foods, foods that induce secretion of acidic enzymes and foods which have natural enzymes in them can cause lesion to the gastro-intestinal tract that can result to hemorrhagic bleeding.

It is safe then to reduce the patient’s diet to “Lugaw” since starch or carbohydrates need only a neutral enzyme in amylase to digest them. It is wise too to give the patients food in small amount to avoid stretching the stomach and most importantly to avoid vomit reflex.

Rest is also a very important factor in the proper care of a dengue patient. Getting the patient to sleep or keep him immobile during the toxic stage when the capillaries are extremely fragile and leaky is a critical factor in avoiding any complications that can result to hemorrhagic bleeding, ascites or pleural effusions.

REMARKS

DENGUE cannot be ascertained until the patients blood is checked for platelet and WBC count. It is therefore wise to bring the patient to the hospital for check-up on the third day of fever however mild the fever is. We have to note that the 3rd or 4th day of dengue fever is the critical stage where the fever may go into remission and can give an impression that the patient has recovered from sickness. In the case of dengue, the sudden drop of fever does not mean recovery but the start of the toxic stage where complications may develop if the patient is not properly taken cared. A Hematology that yields a platelet count below 200, WBC count below normal, and a high lymphocyte differential count is an indication that the patient is at risk of dengue or DHF. A follow-up blood test that shows further drop on the platelet count is a confirmation of a dengue case. Hospital confinement then is required for further observation and rehydration.

During confinement, a doctor may advise that the patient can eat anything except the colored foods because colored food may interfere with the color of the stool which is vital in monitoring the patient for GI bleeding. I stand however with the theory that the safest way to avoid complications such as hemorrhagic bleeding is to avoid foods that can induce secretion of acidic enzymes which can cause lesion to the GI tract. Thus in my outlook, it is wise to put the patient in “Lugaw” diet, avoid meat, fats, acidic foods and drinks including raw foods.

oOo