Dengue hemodynamic assessment

	Stable circulation	Shock (DHF Grade III)*^¶	Prolonged/profound shock (DHF Grade IV)*^¶
Heart rate	Normal	Tachycardia	Severe tachycardia or bradycardia
Blood pressure	Normal	Normal systolic pressure but rising diastolic pressure (narrowing pulse pressure^Δ) Postural hypotension	Severe hypotension or undetectable blood pressure
Respiratory rate	Normal	Tachypnea	Hyperpnea or Kussmaul respirations
Urine output	Normal	Reducing trend	Oliguria or anuria
Consciousness level	Clear, lucid	Clear, lucid	Restless, combative
Capillary refill	Brisk (≤2 seconds)	Prolonged (>2 seconds)	Very prolonged
Extremities	Warm, pink	Cool	Cold, clammy, mottled skin
Peripheral pulse volume	Good volume	Weak, thready	Feeble or absent

DHF: dengue hemorrhagic fever.
* The World Health Organization has established the following grading system for severity of dengue hemorrhagic fever:

DHF Grade I – Fever, hemorrhagic manifestation (positive tourniquet test), and evidence of plasma leakage.
DHF Grade II – DHF Grade I plus spontaneous bleeding.
DHF Grade III – DHF Grade I or DHF Grade II plus narrowing pulse pressure or hypotension.
DHF Grade IV – DHF Grade III plus profound shock with undetectable blood pressure and pulse.

Dengue shock syndrome consists of DHF Grade III and DHF Grade IV.
¶ Shock due to plasma leakage often presents with a narrow pulse pressure or elevated diastolic pressure with preserved systolic pressure, whereas shock due to bleeding often presents with hypotension or low systolic pressure. Other causes of shock must also be considered (such as hypoglycemia, excessive vomiting, or bacterial coinfection).
Δ Pulse pressure is systolic pressure minus diastolic pressure.

Modified from: Centers for Disease Control and Prevention. Dengue case management. Available at: http://www.cdc.gov/dengue/resources/dengue-clinician-guide_508.pdf (Accessed on September 15, 2016).

Graphic 109848 Version 2.0

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Dengue hemodynamic assessment