1. Overview & Management of Dengue Kolitha Sellahewa MBBS.MD.FCCP.FRACP(Hon.) Consultant Physician Epidemiology Unit SRI LANKA

7. Dynamics of Plasma Leakage Dr. Kolitha Sellahewa

8. 0 Hr 24 Hr 48 Hr 6 Hr 36 Hr Rapid Slow Moderate Dr. Kolitha Sellahewa R F C

9. 0 Hr 24 Hr 48 Hr Time of Presentation and Management Dr. Kolitha Sellahewa F C R

15. Timing the onset of critical period 17 th 8 am 18 th 8 am 18 th 8 pm 19 th 8 am 19 th 8 pm 20 th 8 am 20 th 8 pm 21 st 8 am 21 st 8 pm 7500 7000 6500 6000 5500 5000 4500 4000 3500 3000 2500 2000 1500 260,000 240,000 220,000 200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0

16. Timing the onset of critical period platelets WBC 17 th 8 am 18 th 8 am 18 th 8 pm 19 th 8 am 19 th 8 pm 20 th 8 am 20 th 8 pm 21 st 8 am 21 st 8 pm 7500 7000 6500 6000 5500 5000 4500 4000 3500 3000 2500 2000 1500 260,000 240,000 220,000 200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0

20. Convalescent Rash

31. Diffuse blanching erythema

33. Dengue fever

43. Dr. Kolitha Sellahewa

45. Guide to rate of fluid intake in Critical Phase Dr. Kolitha Sellahewa Pulse BP Pulse Pressure CRFT Warmth / Coldness UOP – ml/kg/hr Evidence of Bleeding

51. 0 Hr 24 Hr 48 Hr Time of Presentation and Management F C R

52. DHF Date/Time Febrile Date/Time Critical Date/Time Convalescent Dr. Kolitha Sellahewa

61. Monitoring Chart I - for Management of Dengue Patients – Febrile Phase Dengue Fever D4 without Fever D3 with Fever WBC <5000/mm 3 N-40% L-58% TT + ve Dr. Kolitha Sellahewa

62. Monitoring Chart I - for Management of Dengue Patients – Febrile Phase D4 with Fever TT + ve , WBC <5000/mm 3 N-40% L-58% Tender Liver Dr. Kolitha Sellahewa Entry in to Critical Phase

64. 0 Hr 24 Hr 48 Hr Date/Time Scale 2 Hrs Date/Time Scale 20 Hrs Date/Time Scale 36 Hrs Dr. Kolitha Sellahewa

65. Monitoring Chart II for Management of DHF Patients during Critical Phase Dr. Kolitha Sellahewa

66. Monitoring Chart II for Management of DHF Patients during Critical Phase Dr. Kolitha Sellahewa

67. Monitoring Chart II for Management of DHF Patients during Critical Phase Dr. Kolitha Sellahewa

68. Dr. Kolitha Sellahewa

73. THANK YOU

74. Complications and Adjuvant Therapy Dr. Jayantha Weeraman Consultant Paediatrician Dr. Jayantha Weeraman

76. Bleeding in Dengue Hemorrhagic Fever Phase Early Pre-Shock Shock Prolong-sh Death Severity of Mild of Bleeding Moderate SEVERE Mechanism Drug Vascular injury Platelet Dysfunction Thrombocytopenia Coagulopathy-DIC Fibrinolysis Dr. Kolitha Sellahewa

78. Dr. Jayantha Weeraman

79. Management of fluid overload Frusemide 1 mg/kg Critical Phase Dr. Jayantha Weeraman

82. Dr. Jayantha Weeraman

98. NO PLACE FOR STEROIDS AND IV IMMUNOGLOBULINS IN DENGUE

99. Blood & blood component used in DHF/DSS patients Crystalloid 100% Colloid 20-25% Blood 10-15% Platelet 0.4% Dr. Jayantha Weeraman

102. Dr. Jayantha Weeraman

103. THANK YOU