Tests at Tam Anh General Hospital, Ho Chi Minh City, confirmed Ms. Thai had dengue fever on the 5th day of her illness. The next day, her platelet count dropped to 40 G/L, significantly below the normal range of 150-450 G/L, while her hematocrit (Hct) increased.

Dr. Nguyen Le Phuong Hong, a specialist in infectious diseases at the General Internal Medicine Department, explained that a rapid decrease in platelets coupled with an increase in Hct indicates blood concentration due to plasma leakage from blood vessels. Ms. Thai's blood pressure dropped to 90/70 mmHg, and her cold extremities signaled circulatory compromise.

Doctors diagnosed Ms. Thai with dengue shock, without respiratory failure or altered consciousness. Dengue shock occurs when vascular permeability increases, causing plasma to leak out. This reduces the fluid volume within blood vessels, leading to decreased circulating volume, blood concentration, and potentially low blood pressure and shock. The critical phase typically happens during the fever reduction period, usually from the 3rd to the 7th day of the illness.

Ms. Thai received fluid resuscitation, electrolyte adjustment, and close monitoring. Following the initiation of anti-shock treatment, her blood pressure improved, extremities warmed, pulse became distinct, and perfusion enhanced. The fluid replacement regimen was adjusted flexibly based on her condition. As her hemodynamics stabilized, the infusion rate was gradually reduced, and her hematocrit returned to a safe level.

After the shock phase, Ms. Thai still had a low platelet count and elevated liver enzymes. Ultrasound revealed a small amount of fluid in her abdominal cavity and bilateral pleural effusion. These are manifestations related to plasma leakage in dengue fever, according to Dr. Hong.

After six days of treatment, Ms. Thai's condition improved. Her platelet count increased, liver enzymes trended downwards, and breathing difficulties resolved, leading to her discharge from the hospital.

Doctors advising Ms. Thai before her discharge. Photo: Tam Anh General Hospital

Doctors advising Ms. Thai before her discharge. Photo: Tam Anh General Hospital

Dengue shock is a dangerous complication. Patients may initially experience fatigue, restlessness, cold extremities, pale skin, and reduced urination. Subsequently, blood pressure drops, the pulse weakens, breathing quickens, and they can rapidly progress to circulatory failure. Shock typically occurs when the fever begins to subside and can develop within a few hours.

Dr. Hong advises dengue patients to seek immediate hospital care if they experience severe abdominal pain, persistent vomiting, bleeding, extreme fatigue, agitation, cold extremities, or pale skin. These are warning signs that the illness may be worsening.

During the illness, patients should rest, drink sufficient fluids, and follow medical staff instructions. They should not self-administer intravenous fluids at home or use medication to reduce fever or pain without medical guidance.

To prevent the disease, everyone should actively avoid mosquito bites and eliminate water-holding containers and stagnant water around their homes to limit mosquito breeding sites.

Nhat Thanh

*Patient's name has been changed