Topic:Tetanus, Rabies, AIDS, Dengue, Kala-azar, Japanese Encephalitis.
Question:Describe clinical features and management of dengue shock syndrome.
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Dengue shock syndrome (DSS) is a severe form of dengue fever, a mosquito-borne viral infection caused by the dengue virus. DSS is characterized by a sudden drop in blood pressure, leading to shock, and it is considered a medical emergency. Here are the clinical features and management of dengue shock syndrome:
Clinical Features:
- Sudden Onset of Symptoms:
- DSS often begins with a sudden onset of high fever, severe headache, and pain behind the eyes.
- Joint and muscle pain (breakbone fever) is common and can be severe.
- Bleeding and Petechiae:
- Bleeding manifestations such as petechiae (small red or purple spots on the skin), ecchymosis (bruising), and mucosal bleeding may occur.
- Nosebleeds, bleeding gums, and gastrointestinal bleeding are possible.
- Abdominal Pain and Vomiting:
- Abdominal pain, especially in the upper abdomen, is a common symptom.
- Nausea and vomiting may occur.
- Restlessness and Agitation:
- Patients may become restless and agitated.
- Changes in mental status, such as irritability or confusion, can occur.
- Signs of Shock:
- Hypotension (low blood pressure) is a hallmark sign of DSS.
- Rapid and weak pulse.
- Cold and clammy extremities.
- Decreased urine output.
- Organ Dysfunction:
- As shock progresses, multiple organ dysfunction may occur, leading to respiratory distress, hepatic dysfunction, and renal failure.
The management of dengue shock syndrome (DSS) primarily involves supportive care, as there is no specific antiviral medication for dengue. The focus is on addressing symptoms, preventing complications, and providing supportive measures to stabilize the patient. Here are some medication details that may be used in the management of DSS:
- Intravenous Fluids:
- Crystalloid Solutions: Rapid and aggressive intravenous fluid replacement is a cornerstone of DSS management. Balanced crystalloid solutions such as Ringer’s lactate or normal saline are commonly used to address hypovolemia and maintain fluid balance.
- Blood Transfusion:
- Packed Red Blood Cells (PRBCs): In cases of severe bleeding, transfusion of packed red blood cells may be necessary to replace lost blood and improve oxygen-carrying capacity.
- Platelet Transfusion: If there is severe thrombocytopenia (low platelet count) and significant bleeding, platelet transfusions may be administered.
- Vasoactive Medications:
- Inotropic Agents: Inotropic medications, such as dobutamine, may be used to improve cardiac output and support blood pressure.
- Vasopressors: Vasopressor medications, like norepinephrine, may be administered to constrict blood vessels and raise blood pressure.
- Pain and Fever Management:
- Acetaminophen (Paracetamol): Used for pain relief and to control fever. Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally avoided due to the risk of bleeding.
- Antiemetics:
- Ondansetron: Antiemetic medications like ondansetron may be prescribed to alleviate nausea and vomiting.
- Proton Pump Inhibitors (PPIs):
- PPIs (e.g., Pantoprazole): These may be used to reduce the risk of gastrointestinal bleeding and protect the stomach lining.
- Antibiotics:
- Antibiotics: Antibiotics are not routinely recommended for dengue, as it is a viral infection. However, they may be considered if there is evidence of bacterial co-infection.
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