Dengue haemorrhagic shock: an emergency

In severe dengue, fluid can leave the bloodstream and bleeding may add to the loss of circulating volume. The heart and blood vessels may then struggle to deliver enough oxygen to the body. Early clues can include worsening weakness, restlessness, dizziness, cold clammy skin, rapid breathing, fainting or reduced urine. Fever, headache, muscle aches, joint pain and chills may have occurred earlier, but shock is identified by circulation and organ warning signs, not by fever alone.

Call emergency services or go to the nearest emergency department immediately. Keep the person resting and accompanied, and do not let them walk if dizzy or faint. If they are awake and able to swallow, follow emergency advice about fluids; do not force drinks if they are vomiting, confused or drowsy. Do not give aspirin or ibuprofen unless a treating clinician directs it. Take medication details and relevant medical information, but do not delay transport.

Emergency help is needed for collapse, fainting, confusion, difficulty waking, severe breathing trouble, cold clammy skin, very little urine, blood in vomit or stools, black stools, uncontrolled bleeding or severe abdominal pain. Repeated vomiting and sudden deterioration after fever improves also require urgent assessment. Shock can worsen quickly, so observation at home is unsafe when these signs are present.

Once the person is stable, ask what caused the circulation problem, which monitoring is required, how fluids will be adjusted, and which warning signs mean returning immediately.