Dengue Hemorrhagic Fever

DEFINITIONS
Dengue Hemorrhagic Fever is an acute febrile illness caused by viruses of the genus Flavivirus, family laviviridae.

DIAGNOSTIC STEPS
1. Anamnesis
Fever is a major sign of sudden high place, as long as 2-7 days. Accompanied lethargic, not eating and vomiting. In the big kids can complain of headache, muscle aches and abdominal pain. Diarrhea sometimes - sometimes to be found. Bleeding is the most common skin hemorrhage and nosebleeds.


2. Physical examination
- Clinical symptoms of dengue fever begins suddenly high, facial flush, vomiting, headache, sore muscles and joints, sore throat with pharyngeal hiperemis, pain under right rib arch. Accompanying symptoms are more prominent in the DD than DHF.
- Meanwhile, hepatomegaly and abnormal liver function more frequently found in DHF.
- The difference between DD and DHF occur in DHF is increased capillary permeability, causing plasma leakage, hypovolemia and shock.- Seepage resulted in extravasation of plasma fluid into the pleural cavity and peritoneal cavity for 24-48 hours.
- Critical phase around day 3 to the 5th course of the disease. At this time the temperature falls, which can be the beginning of healing in namaun mild infection in severe DHF is an early sign of shock.
- Bleeding can be ptekie, epistaxis, melena, or hematuria.



- Signs 
- Signs of shockChildren restless until there is a decrease of consciousness, cyanosis.Breathe fast, soft palpable pulse sometimes 
- sometimes not palpable. Decreased blood pressure, pulse pressure <10 mmHg.Akral cold, decreased capillary refillDiuresis decreased till anuria.
- If the shock can not be immediately resolved, there will be complications in the form of metabolic acidosis and severe bleeding.

EXAMINATION SUPPORT
Laboratories
- Complete peripheral blood, hemoglobine levels, and leukocyte counts, hematrokit, platelets.

THERAPY MANAGEMENT
a. DHF without shock (degree I and II)
Medical
- Antipyretics may be given, recommended giving paracetamol instead of aspirin.
- Endeavored not give drugs 
- drugs that are not needed (eg antacid, anti-emetic) to reduce bebab drug detoxification in the liver.
- Corticosteroids given to dengue encephalopathy, gastrointestinal bleeding when there were not given corticosteroids.
- Anti-biotic is given to dengue encephalopathy.


b. DHF with shock (Dengue Shock Syndrome, degree III and IV)
- Replacement of immediate plasma volume, intravenous fluid Ringer's lactate solution 10-20 ml / day in a bolus given within 30 minutes. If the shock is not resolved still given Ringer's lactate 20 ml / kg plus colloidal 20-30 ml / kg / hour, maximum of 1500 ml / day.
- Fluid 10ml/kgbb/jam still be given until 24 hours post-shock. Fluid volume was reduced to 7 ml / kg / day and then 5 ml and 3 ml if good vital signs.
- The amount of urine 1 ml / kg / hour is an indication that the circulation improves.
- In general, the liquid does not need to be given again 48 hours after the shock is resolved.
- Oxygen 2-4 1/menit in dengue shock.
- Correction of metabolic acidosis and electrolyte on dengue shock
- Indication of blood
• There is a clinical bleeding
• After treatment with crystalloid and colloid fluids, shock settled, hematocrit fell, alleged to have occurred bleeding, give fresh blood 10 ml / kg.
• If the hematocrit levels remained> 40 vol%, then give blood in a small volume.
• Fresh frozen plasma and platelet suspension useful for interference correction desiminator intravascular coagulopathy or coagulation (KID) in severe shock which caused massive bleeding.
• The transfusion of platelets on KID suspension must always be accompanied by fresh plasma (containing the coagulation factors necessary) to prevent more severe bleeding.


c. Dengue encephalopathy
- At the encephalopathy and brain edema tends to occur alkalosis, when shock has been overcome, the fluid is replaced with a liquid that does not contain HCO and immediately reduced the amount of fluid. Ringer's lactate solution was immediately exchanged with NaCl solution (0.9%): glucose (5%) = 3: 1.
- DHF patients should be referred to the ICCU of the child to indicate:
• prolonged shock (shock is not resolved more than 60 minutes)
.• Shock over and over (usually caused by bleeding internal.
• severe gastrointestinal bleeding.
• Dengue encephalopathy.