dengue awarness

7/31/2019 Dengue Awarness

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Hi all, This is a follow-up to the below mail that a friend who was kind enough to forward to me a

few weeks ago ( would like to thank you again for forwarding this to me; if not for this mail, I

am not so sure as to whether I would have been able to save my daughter’s life). Since the below mail was helpful to me in saving her life, I thought that it was my duty to put

down my experience and the learning and share it with you and hope that it will help you,

your family, and your friends in beating dengue. My daughter started having very high fever around 1pm on 19

thMay 2012. Although I

immediately gave her Paracetamol, the fever didn’t sett le, and the severe headache and body

aches continued to persist. Towards evening, since the fever still hadn’t come down in

anyway, I started having the feeling that this was different to a normal viral flu. Even though

she eventually fell asleep, she kept tossing and turning, and whining about the body aches

even in her sleep – eventually she woke up and vomited – with this, I started thinking that this

could be dengue – in the middle of the night, I logged into mail and fished the mail on beatingdengue – the mail had mentioned about a test called Dengue Antigen that could be done

within just 24hrs of first symptoms of dengue (very high fever with headache and body aches).

I called the hospital Lab at that time (around 3am) and verified that the test can be done at

the hospital – they also confirmed that the test result would be accurate if the blood test is

done by about 9am the following day (just 16 hrs since the start of symptoms). We received

the result of the test by about 2pm on Sunday (20th

May), which confirmed that my daughter

had contracted Dengue – I immediately admitted her to hospital and the following steps

helped save my daughter’s life: - Having an understanding about the effects of the virus to the body:

The virus starts damaging the blood vessels, and the vessels in turn start to leak

out fluids.

The virus is active in the body for 5 complete days from the start of symptoms

(in the case of my daughter, the doctors started calculating the days from 1pm

of 19th

May), and the effects of the virus reach the optimum stage by the start

of the 4th

day, and continue until the end of the 5th

day – this is the most critical

period, and if not managed well, the body could experience heavy fluid leakage,

which would in turn result in a drop in blood pressure and pulse – the result of

which could be the Dengue Shock Syndrome (DSS), which has been fatal inquite a few instances



- Having an understanding about the treatment:

There’s no cure for dengue; the only way to beat dengue is by fluid

management in the body. The fluid that gets leaked out is replaced through IV

fluid and oral fluid.

The volume of fluid that needs to be replaced is determined through a formula,

which takes into consideration the age of the child, and the average weight of

that age. Fluid management becomes difficult when the child weighs more than the

average weight – eg., my daughter weighed 48kg (as she’s taller than me

although she’s only 11yrs old) at the time of admitting her to the hospital.

However, in order to determine the amount of fluid that needs to be replaced,

the weight used for the calculation is 33kg, which is the average weight for herage; although they adjust the fluid volume required considering the child’s

height, it doesn’t become an accurate calculation, as the formula being used for

an accurate calculation only takes into consideration the average weight of the

age of the child. Fluid intake and fluid output is monitored to ensure the balance of fluid inside

the body; fluid intake is monitored through the fluid that goes in through the IV

and orally, and output is measured through the volume of urine. Fluid intake needs to be done every hour (eg. if the doctor asks you to give

50ml of water per hour, and the child is asleep for 3hours, when the childwakes up, you must make sure that the child is given at least 150ml of fluid).

Fluid output is measured every three hours, and you must try to do this without

letting the child get out of the bed (preferably through the use of a bedpan, as

getting down from the bed could result in a drop in the blood pressure). The

healthy rate of urine output is 0.5-1.0 [the calculation is: (volume of urine

output/the number of hrs since the last time)/weight of the child]. If you make sure that the input and output is done as advised by your doctor,

there is very little chance of the child going into shock.



- Having an understanding about the tests being done, and following up to ensure

that the monitoring is done as requested by the doctor:

The blood is tested for the platelet count, and the pack cell volume (PCV) – this

is done at least thrice a day, and the reports would be ready within 2-3hrs. Platelet count: the virus starts killing the platelets in the body, and within the 5

days, the count could drop to very low levels (in my daughter, it dropped from

209K to 25K) – however, there’s no need to worry about the drop in the

platelet count, as the drop in platelet counts is just an indication of the stage of

the sickness. With the end of the 5th

day, the platelets should start to pickup

(there’s no treatment to be given to increase the platelets; the body would

start to develop platelets with the immunity system starting to function

properly once the virus is out of the body). PCV: this determines the thickness of the blood (the range for females is from

35%-40%) – when there’s vascular leakage, the blood starts to thicken, and

hence decreases the fluidity of the blood (which in turn makes it difficult for

the blood to flow to vital organs in the body). Depending on the change in the

PCV (this is tested every 6hrs during the critical period), the IV and oral fluid

intake is increased to try and increase the fluidity of the blood. Blood pressure and pulse: monitoring of these two is very important during the

critical stage (4th

and 5th

days). A drop in blood pressure and pulse indicate that

the body could be going into shocks. These levels are tested every hour during

the critical stage, and the IV fluid intake is in turn adjusted to manage the lowlevels if any.

Sugar levels: since dextrose might be required to bring down the PCV level, as a

proactive measure, the sugar level is tested to check whether dextrose can be

given or not, if required during the latter stage when the PCV reaches quite

high levels (it went up to 42% for my daughter). Liver functioning: this is done to test the enzyme levels in the liver – in the case

of my daughter, there were very high levels of enzymes in the liver, due to

which, we had to manage the high temperature with just body sponges. Chest x-ray – this is done towards the recovery stage to see whether there is

any fluid accumulated in the lungs; My daughter still has some fluid

accumulated, which is supposed to go off on its own during the course of the

next few days.



Although it is the responsibility of the hospital to ensure that these tests are

done at intervals specified by the doctor, as parents, you have every right to

follow up to ensure that there aren’t any delays, as even a slight delay in

checking your child’s blood pressure could result in him/her going into shocks.

- Admitting the child under a good doctor:

It is very important that your doctor is understanding of your situation, and

interactive - in the case of my daughter, Our doctor explained the importance

of the tests being done, the repercussions if I don’t ensure that my daughter

doesn’t pass urine every three hrs, the repercussions if I don’t get my daughter

to take the oral fluid intake etc., - this helped me understand the situation, and

retain the strength required to get my daughter to drink and pass urine at the

intervals specified by the doctor. He gave me the confidence that my daughter

wouldn’t reach the DSS stage as long as I ensure that she passes urine everythree hours (this has to be done even in the nights during the critical stage – as

such, you must ensure that your child passes urine at least 8 times during the

day during the last two days). - Knowing that your child’s recovery is in your hands:

Whilst it’s important to admit your child under a good physician, 80% of the

responsibility of your child’s recovery lies within the parents (especially the

mother). It is your responsibility to ensure that your child takes the oral fluid and passes

urine at the intervals specified – it becomes your responsibility as only you will

be able to do this. During the infected period (mainly during the last 3 days), your child becomes

very irritable, arrogant and depressive, and convincing your child to drink, and

pass urine become a near impossibility – nevertheless, you have to make sure

that this is done round the clock and as advised by your physician – he/she will

be available to advise you on the levels, but the actual action of getting it done

is your responsibility.



In addition to the above, the following tips, as well, maybe of help:

- If your child has high temperature, with headache and body aches, with a tendency to

persist even after having been given Paracetamol, do the Dengue Antigen test within

the next 24hrs. - Do not give anything else other than Paracetamol to bring down the fever, as other

medicines such as Bruphen and Dollor have the tendency to kill platelets, and would

increase the seriousness of the illness, if what your child has contracted is Dengue.

- When you admit a child with a positive result of the Dengue Antigen test, the doctor

would advise the hospital to have a cannula in place for IV fluids – at this time, also

request for another cannula (the order has to come from the doctor) to be in place for

blood tests. Having this cannula in place for blood tests would help your child

immensely; as otherwise, he/she would need to be pricked at least 4-5 times a dayduring the latter stages. With the cannula in place, the blood can be drawn through

the cannula instead of having to prick each time.

- Try to get your child to use the bed pan for urine collection – each time he/she gets

down from the bed, the blood pressure tends to fall. If your child refuses the use of a

bed pan, request for a mobile commode, that can be brought up to the bed – this

would still cause some sort of pressure loss, but not to the extent it would cause if

he/she needs to walk to the washroom.

- However much everyone keeps saying that the best treatment is at Lady Ridgeway

Hospital (as said in the below mail as well), the number of patients they have to cope

with is too many; in turn your child could get neglected. Hence, having your child

admitted at a reputed private hospital under a physician who has the experience of

managing Dengue well, would help you demand the attention, and the treatment that

you are paying for).

- There is a popular belief that the juice of the small papaw leaves can help increase the

platelet count – there were many who kept suggesting that I too should give this to my

daughter. My advice is that nothing other than what is prescribed by your physician

should be given – due to unnecessary things administered into the body, your child

could develop rashed, allergies, diarrhea, vomiting etc., which would in turn bringdown the blood pressure levels – this could be fatal for your child during the critical

stage of the illness.

- As a preventive measure, make sure that your child wears covered clothes at all times,

and apply mosquito repellant on uncovered areas.



- Be religious, and have faith: I have not been very religious in the last 35yrs of my life,

but there were many times during the last week that I felt only someone superior and

more powerful than a human being could save her for me. I have gone through a lot in

life, but never have I felt more helpless. Seeing my daughter’s health deteriorate in

front of my own eyes was way too much for me – at this time, knowing that there

were friends, colleagues, family, relatives from all over the world, who were prayingfor my daughter to recovery gave me a little bit of hope (would like to quote

something from one texts I got – “there are too many people praying for my

daughter’s recovery – therefore, nothing would go wrong”). I am sorry if the above was too long, but I just wanted to make sure that I noted down all the

tips/learnings from the dreadful experience, which could hopefully in turn help another

parent save his/her child/children from this deadly virus.

What my daughter had was Dengue Hemorrhagic Fever (DHF), which could have reached the

Dengue Shock Syndrome (DSS) level if the fluid management wasn’t done well. There were

days that I went through without any food at all – I just didn’t have the strength or the peaceof mind to think or do anything else, other than being beside my daughter and monitoring her

situation. To be very honest, I started losing hope of being able to take her back home – what I

went through was too much for me, and the very reason for my wanting to put my thoughts

down in this mail as an attempt to help you, your friends, family etc. save the life of another

child. When you have some time, please try and read the following article to get a better

understanding of the virus, and the treatment: http://www.who.int/csr/resources/publications/dengue/024-33.pdf

https://webmail.ambaresearch.com/exchweb/bin/redir.asp?URL=http://www.who.int/csr/resources/publications/dengue/024-33.pdf



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