Beware of nosebleed complications when dengue fever

Nosebleed is one of the dangerous complications of dengue fever, especially dengue fever caused by dengue virus. Dengue hemorrhagic fever if not diagnosed early and treated promptly can lead to death.

Dengue hemorrhagic fever is an infectious disease caused by the dengue virus. This virus is transmitted from an infected person to a healthy person by the bite of the mosquito Aedes aegypti. Although the disease occurs all year round, the disease is common in the rainy season, which is the season when Aedes aegypti mosquitoes breed and develop. Both adults and children are at risk for this disease.

The clinical manifestations of dengue hemorrhagic fever are diverse. The course of the disease is also very fast, from mild to severe.
Usually, the disease has a sudden onset and progresses through 3 stages, namely: the febrile phase, the critical phase, and the convalescent phase.
The early detection and understanding of the clinical manifestations of each stage will help make an accurate diagnosis and timely treatment direction, reducing the risk for sick people.

Sudden high fever and continuous fever. Loss of appetite, nausea. Bleeding under the skin, nosebleed, or bleeding gums. Headache, pain in both eyes. Pain in muscles and joints. Congestive skin. Positive ligature test.

The dangerous stage of the disease usually falls on the 3rd - 7th day of the disease and there are clinical manifestations such as:
The patient still has a fever or has decreased fever.
Patients with dengue fever have plasma leakage due to increased vascular permeability (usually lasting from 24 to 48 hours):
pleural effusion, interstitial tissue, peritoneum, hepatomegaly, eyelid swelling, may hurt. Excessive plasma leakage will cause shock (cardiovascular collapse), with manifestations such as fatigue, restlessness, cold hands and feet, cold and moist skin, rapid and small pulse, blood pressure stuck, blood cannot be measured. low blood pressure or blood pressure, urinating less. Bleeding in places such as:
Subcutaneous hemorrhage: Spots, petechiae scattered on the front of the legs, the insides of the arms, on the abdomen, thighs, ribs, or forming a bruised patch . Mucosal bleeding: Nosebleeds, bleeding gums, bloody urine. Menstrual period or prolonged menstrual period. Internal bleeding: In the digestive system, lungs, the most severe is in the brain. In some severe cases, patients with dengue fever may have organ failure such as severe hepatitis, encephalitis, and myocarditis. However, these manifestations may occur in some patients with no obvious signs of plasma leakage or in shock.

After about 24 - 48 hours of the dangerous phase, the patient shows signs of gradual reabsorption of fluid from the interstitial tissue into the vessel lumen. At this stage, the patient has a number of clinical symptoms such as:
No fever, better general condition, stable hemodynamics, frequent urination. Have an appetite. An electrocardiogram shows that the heart rate may be slow and variable. Excessive perfusion at this stage can lead to pulmonary edema or heart failure in dengue patients.

According to the World Health Organization (WHO), Dengue hemorrhagic fever is divided into 3 levels (2009), that is:
Dengue hemorrhagic fever. Dengue hemorrhagic fever has warning signs. Severe dengue hemorrhagic fever. Depending on the severity of the disease, treatment will vary. In the treatment of Dengue hemorrhagic fever, most cases are symptomatic treatment, outpatient treatment, close monitoring at medical facilities for early detection and prompt treatment when shock occurs. .
Symptomatic treatment:
When a dengue patient has a high fever (≥ 39 degrees Celsius), it is necessary to give antipyretic drugs, wear cool clothes, and wipe with warm water. Antipyretic drugs are indicated as simple paracetamol, dose from 10 to 15 mg/kg body weight/time, spaced every 4-6 hours. Note, the total dose of paracetamol must not exceed 60mg/kg body weight/24 hours. In particular, do not use aspirin (acetyl salicylic acid), analgin, or ibuprofen for treatment because it can cause bleeding and acidosis. Oral rehydration: Dengue patients are encouraged to drink plenty of oresol electrolyte water or cooled boiled water, fruit juices such as coconut water, orange juice, lemon, ...), dilute porridge with salt . With the remaining levels, the patient needs to be hospitalized for treatment according to the protocol of the Ministry of Health.

When there are warning signs such as:
Abdominal pain, nausea or possibly vomiting. Mucous membrane bleeding Lethargy, fatigue, lethargy, restlessness. Abdominal pain in right lower quadrant. The patient is an overweight or obese child. It is necessary to take the patient to the nearest hospital or medical facility immediately to be monitored and treated promptly by doctors to avoid hospitalization in a state of cardiovascular collapse. Thus, the new treatment brings better results.