Dengue Hemorrhagic Fever (DHF) is caused by the dengue virus and is transmitted by the Aedes Aegypti mosquito. DHF often occurs in Southeast Asia, the Western Pacific, Central and South America, and Africa. Living or traveling to one of these areas, especially in suburban areas, will increase the risk of developing dengue disease. Patients suffering from DHF usually experience severe pain, skin rash, joint pain, and high fever. Here are some ways to treat patients infected with dengue.
Step
Part 1 of 3: Making a Diagnosis
Step 1. Know the incubation period
The symptoms of dengue will appear about one week after a person is infected. These symptoms will determine the severity and treatment plan needed by the patient.
Once you are bitten by a mosquito, symptoms will appear within four to seven days. These symptoms usually last about three to ten days
Step 2. Consider whether the patient is showing any serious signs
There are two main classifications of DHF: with and without warning signs.
- DHF without warning is usually characterized by a fever (40 degrees Celsius) and two or more of the following symptoms: nausea/vomiting; a rash that causes a flushed face; red spots on the arms, legs, chest, and back; body aches and aches; low white blood cell count; and swollen glands in the neck and behind the ears.
- DHF with warning is classified similarly to DHF without warning, but patients in this category exhibit one or more of the following symptoms: abdominal pain; persistent vomiting; fluid buildup in the stomach and lungs; bleeding from the gums, eyes, nose; feeling tired or tired; enlarged liver.
- Warning signs like these indicate a serious dengue infection that can progress to bleeding and organ failure. This is called DHF (Dengue Hemorrhagic Fever). If one (or more) of the above symptoms appear, the patient must be immediately taken to the hospital within the first 24-48 hours, or the consequences can be fatal.
Step 3. Determine if the patient has severe DHF
Severe dengue includes symptoms from both of the above classifications, as well as any of the following signs:
- Heavy bleeding or blood in the urine
- Accumulation of fluid in the stomach and lungs
- Loss of consciousness
- Effects on other organs of the body, such as the heart, leading to accumulation of extra fluid, low blood pressure, and a high pulse rate
- If any of these symptoms are detected, immediately take the patient to the nearest hospital.
Step 4. Visit the hospital for a checkup
All DHF patients who are accompanied by warning signs should go to the hospital immediately. Those who experience dengue fever without warning should also visit the hospital for a thorough examination and confirm the diagnosis.
Step 5. Decide where the treatment will be carried out
This treatment can be carried out at home or in a hospital. For severe cases/showing warning signs, the patient should be hospitalized.
- Home care only can be taken if the patient meets the following three requirements: 1) no warning signs appear; 2) the patient can tolerate adequate levels of fluids orally; 3) the patient can urinate at least every six hours.
- Know that there is no specific treatment that can cure dengue. The treatment given is usually only focused on overcoming the symptoms of DHF.
Part 2 of 3: Caring for DHF Patients at Home
Step 1. Keep the environment clean so that it is free of mosquitoes
When treating dengue patients at home, make sure you prevent further contact with mosquitoes - because this disease can be transmitted through mosquitoes. In other words, the key to preventing the spread of disease is to control the mosquito population.
- Use window and door screens in your home to keep mosquitoes out.
- Use mosquito nets while sleeping.
- Wear clothing that minimizes skin exposure to mosquitoes.
- Apply mosquito repellent on exposed skin. Some types of mosquito repellent that are effective are Sari Puspa, Autan, picaridin, and lemon eucalyptus oil. Children should not use it alone. Adults should apply mosquito repellent to their hands, then to children's skin. Do not use mosquito repellent on children under two months of age.
- Prevent mosquito breeding by draining stagnant water sources in your home and cleaning water storage containers regularly.
Step 2. Take the DHF patient to the hospital every day
DHF patients have to go to the hospital every day to have their blood checked and the state of their fever. These daily visits should be carried out as long as the patient's fever exceeds 37.5 degrees Celsius. You can stop the visit after the fever has disappeared for more than 48 hours.
Step 3. Ensure that the patient is adequately rested
Allow the patient to return to activities gradually, especially if the period of illness is long.
Because DHF often causes significant fatigue and fatigue, patients should take frequent breaks and return to their routines with caution
Step 4. Give acetaminophen/paracetamol (eg Tylenol®) to the patient
This treatment will help with the fever. Give one tablet at a dose of 325 to 500 mg. You can give up to four tablets a day.
Do not give aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs can increase the risk of bleeding in those who have dengue
Step 5. Make sure the patient drinks plenty of fluids
Patients should be encouraged to drink water, fruit juices and oral rehydration fluids to prevent dehydration caused by fever/vomiting.
- Adequate fluid intake reduces the chances of the need for DHF patients to be hospitalized.
- Men and women (aged 19 to 30) should drink 3 and 2.7 liters of water daily. Boys and girls: 2, 7 and 2, 2 liters of water daily. Infants should drink 0.7-0.8 liters/day.
- You can also prepare the juice by using papaya leaves. Papaya leaf extract is reported to increase the number of platelets in DHF patients, although there is no clinical research that proves it.
Step 6. Keep a symptom diary
Keeping a diary will help you keep track of any worsening symptoms. You should monitor children and infants closely as they are more likely to have more severe dengue attacks. Note the following:
- Temperature at the patient's body temperature. Since the temperature will vary throughout the day, record your temperature at the same time each day. This way, your diary will be trusted and valid.
- Fluid intake. Have the patient drink fluids from the same cup each time; so that it is easier for you to remember and record the total volume he consumed.
- Urine output. Ask the patient to pee in a container. Measure and record the amount of urine each time. These containers are commonly used in hospitals to measure urine output within 24 hours. You can buy or ask about the urine container at the hospital.
Step 7. Take the patient to the hospital if the symptoms get worse
Go to the hospital immediately if he shows any of the following symptoms:
- High fever
- Severe stomach ache
- Continuous vomiting
- Body chills and extremes (can result from dehydration or loss of blood)
- Fatigue
- Confusion (due to lack of water intake or bleeding)
- Inability to urinate regularly (at least every 6 hours)
- Bleeding (eg from the vagina, nose, eyes / gums, and the presence of red dots on the skin)
- Difficulty breathing (due to accumulation of fluid in the lungs)
Part 3 of 3: Caring for DHF Patients in Hospital
Step 1. Give intravenous fluids
To treat severe cases of DHF in the hospital, the doctor will insert intravenous (IV) fluids and electrolytes (salt solution) into the patient's body. This treatment only serves to replace fluids lost through vomiting or diarrhea. This step is only performed if the patient is unable to take fluids orally (eg due to continued vomiting) or is in a state of shock.
- Intravenous means "inside a vein". In other words, the fluid will be injected directly into the patient's vein using a syringe or intravenous catheter.
- The recommended IV fluid is crystalloid (0.9% salt).
- The doctor will monitor the patient's fluid intake through the IV method based on IV fluid injection guidelines which are more careful than in the past. This is because overhydration (excess fluids) can have serious effects, including excessive IV fluid loading, or capillary flooding. That's why, in most cases, the doctor will give fluids gradually instead of constant.
Step 2. Request a blood transfusion
In more serious and severe cases of dengue, the doctor may have to give a transfusion to replace the lost blood. Transfusion is usually required for DHF patients whose cases have reached the stage of DHF.
Transfusions can introduce fresh blood into the patient's system or just his platelets. Platelets are the part of blood that helps clotting and are smaller than white and red blood cells
Step 3. Request a corticosteroid injection
Corticosteroids are man-made drugs that are similar to cortisol - a hormone produced naturally by the adrenal glands. These drugs reduce inflammation and activity of the immune system.
