🩺 General MedicineInfectious / Vector-borneStudentInternResident

Dengue

Also known as: break-bone fever · dengue fever · DHF

An Aedes-borne viral febrile illness. Most cases self-limit, but plasma leakage can cause severe dengue — early recognition of warning signs and careful fluid therapy save lives.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

People in endemic tropical/urban areas; the day-biting Aedes aegypti is the main vector. A second infection with a different serotype raises the risk of severe dengue.

Red flags — escalate / refer

WHO warning signs (often as the fever falls): severe abdominal pain, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy/restlessness, liver enlargement >2 cm, or a rising haematocrit with a rapid platelet fall → admit.
Severe dengue = severe plasma leakage/shock, severe bleeding, or organ impairment → intensive care.
Avoid NSAIDs/aspirin and intramuscular injections (bleeding risk).

Work-up / diagnosis

1Confirm: NS1 antigen (days 1–5) and/or IgM (after day 5) or RT-PCR.
2Serial CBC — track haematocrit (haemoconcentration) and platelet trend.
3Classify: dengue without warning signs / with warning signs / severe dengue. Watch the critical phase around defervescence (≈ day 3–7).

Management — overview

No warning signs: home care — oral fluids, paracetamol for fever, rest; AVOID NSAIDs/aspirin; review daily and educate on warning signs.
With warning signs / severe: admit and give judicious isotonic crystalloid titrated to haematocrit, vitals and urine output — avoid both under- and over-hydration.
Transfuse platelets only for significant bleeding, not for a low count alone; manage shock per the WHO algorithm.
Monitor closely through the critical phase; there is no specific antiviral.

In-depthFull dosing & advanced protocol

Drug dosing

Paracetamol (acetaminophen)

Fever/pain — NSAIDs and aspirin are contraindicated

Adult dose: 500 mg–1 g every 4–6 h (max 3–4 g/day per local guidance)
Paediatric: 10–15 mg/kg/dose, 4–6 hourly
Route: Oral

Caution: Do NOT use ibuprofen/aspirin (bleeding); avoid IM injections.

WHOWHO — Dengue & clinical management of arboviral diseases (2025) ↗

Isotonic crystalloid (Ringer's lactate / 0.9% saline)

Warning signs / severe dengue

Adult dose: Titrate per the WHO fluid algorithm (e.g. start ~5–7 mL/kg/h, then taper), guided by haematocrit, vitals and urine output
Route: Intravenous

Caution: Reassess frequently — over-hydration causes effusions/respiratory distress.

WHOWHO — Dengue & clinical management of arboviral diseases (2025) ↗

Fluids, shock & monitoring

Follow the WHO step-wise fluid algorithm for compensated vs hypotensive shock; use colloids for refractory shock per guidance.
The critical (leakage) phase lasts 24–48 h around defervescence — most deterioration happens here.
Expanded dengue syndrome (hepatitis, encephalopathy, myocarditis) can occur; watch organ function.

WHOWHO — Dengue & clinical management of arboviral diseases (2025) ↗

Diagnosis timing & prevention

NS1 is best early (days 1–5); IgM after ~day 5. Combine tests by phase of illness.
Vector control is the mainstay of prevention; the QDenga vaccine is recommended only for ages 6–16 in high-transmission settings.

MoHFWNCVBDC (formerly NVBDCP), India — National Guidelines for Dengue ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

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Dengue

Also known as: break-bone fever · dengue fever · DHF

An Aedes-borne viral febrile illness. Most cases self-limit, but plasma leakage can cause severe dengue — early recognition of warning signs and careful fluid therapy save lives.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

Red flags — escalate / refer

WHO warning signs (often as the fever falls): severe abdominal pain, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy/restlessness, liver enlargement >2 cm, or a rising haematocrit with a rapid platelet fall → admit.

Severe dengue = severe plasma leakage/shock, severe bleeding, or organ impairment → intensive care.

Avoid NSAIDs/aspirin and intramuscular injections (bleeding risk).

Management — overview

No warning signs: home care — oral fluids, paracetamol for fever, rest; AVOID NSAIDs/aspirin; review daily and educate on warning signs.

With warning signs / severe: admit and give judicious isotonic crystalloid titrated to haematocrit, vitals and urine output — avoid both under- and over-hydration.

Transfuse platelets only for significant bleeding, not for a low count alone; manage shock per the WHO algorithm.

Monitor closely through the critical phase; there is no specific antiviral.

Drug dosing

Paracetamol (acetaminophen)

Fever/pain — NSAIDs and aspirin are contraindicated

Adult dose: 500 mg–1 g every 4–6 h (max 3–4 g/day per local guidance)
Paediatric: 10–15 mg/kg/dose, 4–6 hourly
Route: Oral

Caution: Do NOT use ibuprofen/aspirin (bleeding); avoid IM injections.

WHOWHO — Dengue & clinical management of arboviral diseases (2025) ↗

Isotonic crystalloid (Ringer's lactate / 0.9% saline)

Warning signs / severe dengue

Adult dose: Titrate per the WHO fluid algorithm (e.g. start ~5–7 mL/kg/h, then taper), guided by haematocrit, vitals and urine output
Route: Intravenous

Caution: Reassess frequently — over-hydration causes effusions/respiratory distress.

WHOWHO — Dengue & clinical management of arboviral diseases (2025) ↗

Fluids, shock & monitoring

Follow the WHO step-wise fluid algorithm for compensated vs hypotensive shock; use colloids for refractory shock per guidance.

The critical (leakage) phase lasts 24–48 h around defervescence — most deterioration happens here.

Expanded dengue syndrome (hepatitis, encephalopathy, myocarditis) can occur; watch organ function.

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Paracetamol (acetaminophen)

Isotonic crystalloid (Ringer's lactate / 0.9% saline)

📈 Fluids, shock & monitoring

📈 Diagnosis timing & prevention

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Paracetamol (acetaminophen)

Isotonic crystalloid (Ringer's lactate / 0.9% saline)

📈 Fluids, shock & monitoring

📈 Diagnosis timing & prevention

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Fluids, shock & monitoring

Diagnosis timing & prevention

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Fluids, shock & monitoring

Diagnosis timing & prevention

References