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 pressureΔ) 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: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.