A guide to DHF/DSS management - the Singapore experience.
提要A guide to the medical management of dengue for reducing its case-fatality rate as experienced in Singapore is furnished. The mortality from dengue in Singapore is low and most cases recover uneventfully. However, complacency and under-estimation of the disease does occur. It is important to recognize the symptoms of severity and understand the patho-physiology that leads to dengue shock syndrome (DSS). A protocol giving indications of platelet transfusion will guide appropriate usage. Patients should be informed prior to platelet transfusion as to its possible dangers. In our experience, with good initial appropriate support in a stable patient, platelet transfusion is seldom needed till the platelets fall below 10,000/mm3. DSS is reversible if appropriately treated with fluids and plasma infusion to reverse the osmotic permeability gradient due to hypoalbumenaemia. Severe pulmonary oedema causes adult respiratory distress syndrome (ARDS). The lung effusions and hypotension must be differentiated from other causes of shock and pulmonary oedema. Correction of acid-base balance and internal bleeding if present, recognition and appropriate treatment of septicaemia and pneumonia, and avoiding fluid overload usually result in recovery. Nosocomial and mycoplasma pneumonias, not uncommonly, complicate severe ARDS. Fatalities are often from these unrecognized infections.
Teik, Oon Chong. (2001). A guide to DHF/DSS management - the Singapore experience.. WHO Regional Office for South-East Asia. http://www.who.int/iris/handle/10665/163637