01/02/2026
Dengue Fever: Warning Signs, Management, and Prevention
(Based on WHO-aligned Nursing Perspective)
Introduction
Dengue fever is an acute viral illness transmitted by the bite of an infected Aedes aegypti mosquito. It is a major public health problem in tropical and subtropical regions, including India. While many cases are mild, dengue can rapidly progress to severe dengue, leading to plasma leakage, shock, bleeding, and organ failure. Early recognition of warning signs and timely nursing and medical management are crucial to reduce morbidity and mortality.
This article focuses on warning signs, management steps, and preventive measures of dengue fever, as highlighted in the Dengue Fever – Part 02 infographic.
Warning Signs of Dengue (Mnemonic: ABC PLS)
Recognition of warning signs is critical, especially during the critical phase (after day 3–5 of fever).
A – Sudden High-Grade Fever
Abrupt onset of high fever (often >39°C)
Usually associated with severe body ache and headache
B – Bleeding Manifestations
Bleeding from gums and nose
Petechiae or purpura on skin
Gastrointestinal bleeding in severe cases
C – Clinical Fluid Accumulation
Ascites
Pleural effusion
Indicates plasma leakage and risk of shock
P – Persistent Vomiting
Vomiting more than 3 times in 24 hours
Suggests worsening disease and dehydration
L – Lethargy or Restlessness
Altered sensorium
Sign of reduced cerebral perfusion or shock
S – Sudden Drop in Platelets with Rising Hematocrit
Thrombocytopenia with hemoconcentration
Strong indicator of plasma leakage
➡️ Presence of any warning sign requires immediate hospital admission and close monitoring.
Management of Dengue (Mnemonic: FLUIDS)
There is no specific antiviral treatment for dengue. Management is mainly supportive, focusing on fluid balance and prevention of complications.
F – IV Fluid Therapy
Use Normal Saline (NS) or Ringer’s Lactate (RL)
Avoid over-hydration to prevent pulmonary edema
Titrate fluids based on vitals, urine output, and hematocrit
L – Laboratory Investigations (After Day 5)
Complete Blood Count (CBC)
Dengue IgM and IgG antibodies
Serial hematocrit monitoring to assess plasma leakage
U – Urinary Output Monitoring
Maintain urine output ≥ 0.5 mL/kg/hour
Reduced output indicates worsening shock or renal impairment
I – Inotropes
Dopamine is used if patient develops shock not responding to fluids
Continuous monitoring of blood pressure is essential
D – Drugs
Paracetamol for fever and pain
Avoid NSAIDs and aspirin due to bleeding risk
S – Supportive Care
Maintain adequate hydration
Monitor for bleeding, cold extremities, hypotension
Oxygen support if required
Platelet Transfusion: Important Note
Not routinely indicated
Recommended only in cases of severe bleeding or very low platelets with active hemorrhage
Prophylactic platelet transfusion is discouraged
Prevention of Dengue
Since dengue has no specific cure, prevention is the most effective strategy.
Key Preventive Measures:
Prevent mosquito bites (repellents, nets, coils)
Eliminate stagnant water (coolers, pots, tyres)
Wear full-sleeve protective clothing
Community fogging during outbreaks
Health education and community participation
Role of Nurses in Dengue Care
Early identification of warning signs
Accurate fluid balance charting
Monitoring vitals, urine output, and bleeding
Patient and family education
Preventing complications through vigilant care
Conclusion
Dengue fever can rapidly progress from a mild febrile illness to a life-threatening condition if warning signs are missed. The ABC PLS mnemonic helps in early recognition, while FLUIDS provides a structured approach to management. Nurses play a pivotal role in monitoring, supportive care, and prevention. With timely intervention and community-based preventive measures, dengue-related mortality can be significantly reduced.
