## Clinical Assessment This patient presents with **dengue haemorrhagic fever (DHF) with dengue shock syndrome (DSS)** — evidenced by: - Day 5 of illness (critical phase) - Thrombocytopenia (45,000/μL) - Positive tourniquet test (≥20 petechiae = positive; 15 is borderline but in context of other signs) - Hypotension (92/58) and tachycardia (118/min) - Signs of shock: prolonged capillary refill (3 sec), restlessness - Plasma leakage manifestations: abdominal pain, vomiting ## Management Principles in DSS **Key Point:** Dengue shock is primarily **hypovolaemic shock due to plasma leakage**, NOT haemorrhagic shock. The priority is fluid resuscitation, not transfusion. **High-Yield:** The WHO and Indian guidelines recommend: 1. **Crystalloid resuscitation** at 10–20 mL/kg/hr (or 1 mL/kg/min) during shock 2. Monitor urine output (target 0.5 mL/kg/hr in adults) 3. Reassess after 15–30 min; reduce rate once BP normalizes 4. **Platelet transfusion only if:** - Active bleeding (not just low count) - Platelet count < 10,000/μL with risk of spontaneous bleeding - Procedure planned **Warning:** Prophylactic platelet transfusion (transfusing to "normalize" the count) is **contraindicated** — it increases risk of fluid overload and worsens plasma leakage. **Clinical Pearl:** Platelet count does NOT correlate with bleeding risk in dengue. A patient with 20,000/μL may have no bleeding, while another with 80,000/μL may bleed due to coagulopathy. Transfuse based on **clinical bleeding**, not numbers. ## Why This Answer Option 1 (IV fluids, monitor, transfuse if bleeding) is the **single best answer** because it: - Addresses shock with appropriate fluid resuscitation - Avoids unnecessary transfusion - Follows WHO/Indian guideline protocols for DSS management [cite:WHO Dengue Guidelines 2009, Harrison 21e Ch 189]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.