Why is rehydration necessary in the treatment of dengue fever?

The article is expertly consulted by Master. Doctor Nguyen Thi Nhat - Doctor of Infectious Diseases - Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital. The doctor has more than 10 years of experience in the field of artificial kidneys, and in the field of infectious diseases, examining and managing patients with kidney disease and infectious diseases.

Dengue fever treatment requires timely and proper rehydration of fluids and electrolytes to limit serious consequences caused by dehydration, such as shock, pulse collapse, coma, and neurological disorders.

Currently, there is no specific drug to treat dengue infection. Therefore, when dengue fever is suspected, the patient should see a doctor as soon as possible for an accurate diagnosis and appropriate treatment. Dengue fever treatment is mainly about symptom management and prevention of more serious complications.
To treat dengue at home, patients need to use pain relievers with the active ingredient acetaminophen (paracetamol) and avoid medicines containing aspirin, which can make bleeding worse. In addition, the patient should rest, drink plenty of water and replenish electrolytes. If the patient feels worse in the first 24 hours after the fever is gone, the patient needs to go to the hospital to be checked and treated for complications when the dengue fever worsens.

Some patients with severe dengue present with severe dehydration. This is the most common complication in dengue cases and also the main cause of death, related to plasma leakage.

Patients have symptoms of digestive disorders, severe diarrhea, accompanied by vomiting, fatigue, lethargy, pain in the liver, ... Many healthy people can be subjective, not paying attention to the phenomenon of dehydration. , leading to massive bleeding, plasma is leaked through the vessel wall, leading to water movement, resulting in a large amount of water loss in the circulatory system. Consequences cause shock, cardiovascular collapse, coma, liver and kidney dysfunction... In which, complications of hemorrhagic fever and thrombocytopenia are considered extremely dangerous. Some of the symptoms of thrombocytopenia hemorrhagic fever include:
Bruising; Tooth bleeding, nose bleeds; Continuous bleeding from an open wound, even if the wound has been present for a long time; Heavy menstrual bleeding; Rectal bleeding. Blood in stool or urine; Fatigue, dizziness, lightheadedness, lethargy. In more severe cases of thrombocytopenia, the person may experience internal bleeding. Some signs of internal bleeding include:
Blood in the urine; Blood in stools; Vomiting blood or black fluid.

The majority (70%) of dengue patients without shock can be managed as an outpatient with oral rehydration. However, the remaining 30% and all dengue patients with shock require intravenous (IV) water treatment.
Oral rehydration therapy is recommended as first line for patients who are moderately dehydrated due to high fever and vomiting. Patients with diagnosed or suspected dengue should have their platelet count and hematocrit measured daily from the third day of illness onset until 1-2 days after deflation. Accordingly, patients with poor appetite, severe vomiting, clinical signs of dehydration, increased hematocrit level or decreased platelet count can perform rehydration fluids under close medical supervision.

The work of rehydrating fluids for dengue fever patients should be prescribed and performed by a doctor, applied to certain patient populations, with signs of severe dehydration shown on subclinical, such as: such as:
Tachycardia; Long capillary loading time; Skin that is cool or appears mottled or mottled; There are manifestations of neurological disorders; Decreased urine output; Hematocrit increased; Low blood pressure. Improvements can be observed in the outpatient setting. However, patients treated for dengue who do not improve should continue to stay in the hospital to find appropriate rehydration management.
Rehydration with intravenous fluids can prevent dehydration and stabilize blood volume if the patient cannot maintain oral rehydration. In addition, in rare cases if the platelet level drops significantly (to less than 20,000) or if there is severe bleeding, the doctor will prescribe a platelet transfusion for the patient. When a dengue patient passes black stools, gastrointestinal bleeding is most likely occurring, platelet and/or red blood cell transfusions are necessary to bring the patient through the critical phase.

During the critical period of dengue in children, there is increased capillary permeability and shock can occur if large volumes of plasma are lost due to fluid leakage. The recommended regimen for the treatment of dehydration in children with dengue is: Rapid replacement and amelioration of plasma loss with isotonic water and electrolyte solutions or macromolecular solutions (in the case of shock); continue to perform continuous plasma resuscitation to maintain the circulatory system for 24-48 hours; correct metabolic and electrolyte disturbances; blood transfusion in case of severe, life-threatening bleeding. In cases where large amounts of fluid are required, the volume of infusion should be gradually reduced as the plasma leakage shows signs of improvement, in order to prevent complications of hypocalcaemia and edema caused by excess plasma, leading to respiratory failure or congestive heart failure, especially during the recovery period.

Dengue patients in the early stages can self-rehydrate at home orally. It is best to use the following solutions:
Oresol solution (ORS): Prepare according to the manufacturer's instructions. Should be mixed with boiled water to cool, avoid mixing with milk, mineral water or juice. Do not add sugar to the solution after mixing, do not split the ORS package to be mixed into many times as well as too concentrated, because it will reduce the efficiency of use; Juice: To rehydrate dengue patients, you can use fruit juices, such as orange juice, lemon juice, coconut water. Fruit juices both provide water and electrolytes, and contain many essential vitamins and minerals, help strengthen the immune system, increase the stability of the vessel walls, thereby reducing the risk of bleeding; Filtered water: Dengue patients need to rehydrate enough in the treatment of dengue fever, focus on resting and supplementing with adequate nutrition. In any case, whether dengue fever can be infused with water depends on the prescription of the treating doctor. In addition, patients can self-rehydrate at home orally to improve symptoms.

Reference source: Webmd.com; Denguevirusnet.com and Ncbi.nlm.nih.gov