Q: A child with fever and abdominal pain tested positive for Dengue on day 5 of fever. His BP was 110/70 mm Hg, platelet counts were 20,000/mm3, but there were no bleeding manifestations. What is the next step?

1. A

   Platelet transfusion

2. B

   10 ml/kg/hr RL

3. C

   7 ml/kg/hr RL

4. D

   20 ml/kg RL

Appeared in: INI-CET EXAM -2025

Explanation

• The patient has Dengue with a warning sign (abdominal pain), which requires hospitalization and initiation of intravenous fluids.
• The patient is hemodynamically stable (BP 110/70 mm Hg) and not in shock.
• According to WHO guidelines for Dengue with warning signs in a stable patient, IV fluid therapy should be started with an isotonic crystalloid (like Ringer's Lactate) at a rate of 5-7 mL/kg/hr.
• Starting with 7 mL/kg/hr is the most appropriate initial step to manage plasma leakage and prevent progression to shock.

Why Other Options Were Wrong

• Option A: Prophylactic platelet transfusion is not indicated in Dengue without active, severe, or life-threatening bleeding. It does not prevent hemorrhage and can cause fluid overload.
• Option B: This is a higher infusion rate. It is not the appropriate initial rate for a stable patient. It is a step-up therapy.
• Option D: This is a large fluid bolus used for resuscitating a patient in shock (hypotension, narrow pulse pressure). This patient is hemodynamically stable.

Related Visual

• Visual 1: Flowchart: WHO Dengue Treatment Algorithm, showing the decision points for Group B (Dengue with warning signs) vs. Group C (Severe Dengue/Shock).
• Visual 2: Table: Comparing the management of Dengue without warning signs, with warning signs, and severe Dengue, highlighting differences in fluid rates and interventions.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Dengue Fever with Warning Signs as background academic context rather than a clinical decision trigger.
• Judicious fluid management is the cornerstone of treating Dengue. The nurse's role in accurately monitoring intake, output, vital signs, and signs of fluid overload or worsening shock is critical to prevent mortality.
• Nurses must be vigilant for warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding) that signal the transition to the critical phase, prompting immediate escalation and intervention.
• Understanding that low platelet counts alone are not an indication for transfusion is a key patient safety principle in Dengue management, preventing iatrogenic harm from fluid overload.

How to Approach the Question

• First, identify the patient's disease and stage. The question states the child has Dengue on day 5 with abdominal pain, which is a 'warning sign' for severe Dengue.
• Next, assess the patient's hemodynamic stability. The BP is 110/70 mm Hg, which is stable. This rules out Dengue Shock Syndrome.
• Recall the management guidelines for Dengue with warning signs but no shock. The primary intervention is to start IV fluids to manage plasma leakage.
• Compare the fluid rate options. A bolus (20 ml/kg) is for shock. A high rate (10 ml/kg/hr) is for worsening conditions. The standard starting rate is 5-7 ml/kg/hr.
• Evaluate the non-fluid option. Platelet transfusion is only for severe bleeding, not for low counts alone.
• Select the option that matches the standard initial fluid rate for this clinical picture, which is 7 ml/kg/hr RL.

Concept Tested & Keywords

• Concept Tested: Management of Dengue Fever with Warning Signs
• Stem keywords: Dengue, fever, abdominal pain, platelet counts 20,000/mm3, no bleeding manifestations
• Lead-in keywords: next step
• Clinical cues: Abdominal pain is a critical 'warning sign' in Dengue, signaling the need for hospitalization and close monitoring.
• Clinical cues: Platelet count of 20,000/mm3 indicates severe thrombocytopenia, a hallmark of the critical phase of Dengue.

Question ID

QUt05guKj-Q_iOqbEo_rrv

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