On July 4, 2023, the Ministry of Health issued Decision No. 2760/QD-BYT regarding the Guidelines for the Diagnosis and Treatment of Dengue Hemorrhagic Fever, replacing the 2019 guidelines. This is currently the most critical legal document, standardizing treatment procedures at medical facilities nationwide to minimize mortality and complications.

General Overview and Clinical Phases

Dengue Hemorrhagic Fever is an acute infectious disease caused by the Dengue virus, with Aedes aegypti mosquitoes being the primary vector. The disease progresses through 3 phases: the febrile phase, the critical phase, and the recovery phase. Correctly identifying the phase is a prerequisite for timely management.

• Febrile Phase: Patients experience sudden, continuous high fever, which may be accompanied by anorexia, nausea, congestive skin, muscle pain, joint pain, or retro-orbital pain.

• Critical Phase: Usually occurs from the 3rd to the 7th day of the illness. At this time, the patient may still have a fever or the fever may have subsided, but complications such as plasma leakage, thrombocytopenia, and coagulation disorders may appear.

Warning Signs Requiring Hospitalization

According to the new guidelines, children or adults with the following warning signs require immediate hospitalization: restlessness, lethargy, persistent vomiting, severe abdominal pain, signs of dehydration, or hepatomegaly. Regarding paraclinical tests, a high Hematocrit (Hct) index accompanied by a rapid decrease in platelets is a significant indicator of hemoconcentration.

Treatment Principles and Medication

For Dengue Hemorrhagic Fever without warning signs, patients can be treated as outpatients but require close monitoring.

• Fever Reduction: Use single-ingredient Paracetamol, dosage from 10-15mg/kg body weight/dose, every 4-6 hours if fever is ≥ 38.5°C.

• Contraindications: Absolutely do not use Aspirin, Analgin, or Ibuprofen for fever reduction as these drugs can cause acidosis and aggravate bleeding.

• Fluid Replacement: Patients are encouraged to drink plenty of fluids (ORS, fruit juice). Intravenous fluid administration is performed only upon a doctor’s prescription, especially when the patient cannot drink or vomits excessively.

In cases of Dengue Shock Syndrome (rapid pulse, hypotension, or narrow pulse pressure), urgent anti-shock resuscitation must be conducted using electrolyte solutions (Ringer lactate, NaCl 0.9%) or colloids strictly following the Ministry of Health’s protocol.

MSc. Nguyen Nam Anh – Center for Support & Continuing Education