Dengue Warning Signs: When to Go to Hospital

Faridabad sees most of its dengue between August and November, with the peak after the monsoon — standing water from the rains gives the mosquito a month of breeding sites, and cases follow a few weeks behind. If someone in the house has a high fever right now, this is the season to take it seriously.

What dengue actually does

Dengue is a virus carried by the Aedes mosquito, which — unlike the malaria mosquito — bites in the daytime, often around dawn and dusk, and breeds in clean standing water rather than drains.

The illness usually starts abruptly: fever that climbs fast, a severe headache, pain behind the eyes, and deep aching in the muscles and joints. Some people get a rash a few days in. It is often described as feeling worse than flu, and for most people that is the whole story — three to seven unpleasant days, then recovery.

There is no medicine that kills the virus. Everything that helps is supportive: fluids, rest, paracetamol for the fever, and watching for the small number of cases that turn.

Day three to seven is the window that matters

This is the part worth understanding properly, because it runs against instinct.

In dengue, the dangerous phase begins as the fever falls, usually somewhere between day three and day seven. What can happen at that point is that fluid starts leaking out of the small blood vessels. The person may feel briefly better — the fever has broken, after all — and then get rapidly worse.

So a temperature coming down on day four is not, on its own, reassurance. It is the point at which to watch more closely, not less. The next 48 hours are when the warning signs below tend to show up.

The warning signs

These are the signs that mean the illness may be moving into its severe form. Any single one of them justifies going to a hospital the same day.

• Severe or worsening stomach pain — not general discomfort, but pain that makes someone double over or that keeps getting worse.
• Persistent vomiting — roughly three or more times in an hour, or being unable to keep any fluid down.
• Bleeding — gums, nose, unusual bruising, blood in vomit or stool, or in urine. In women, an unexpectedly heavy period during dengue counts.
• Difficulty breathing, or breathing that has become fast and shallow.
• Cold, clammy or mottled skin, or a person who looks pale and feels cold to touch despite having had a fever.
• Extreme tiredness, restlessness or confusion — a sudden change in how someone is behaving matters as much as any number.
• Not passing urine for six to eight hours.

In children, add: refusing to drink, no wet nappies, no tears when crying, drowsiness, or being floppy and hard to rouse. Children can deteriorate faster than adults and give you less warning, which is why any of these in a child is a reason to come in rather than wait and see.

Looking after someone at home

For uncomplicated dengue, home care is genuinely the right treatment, and most of it is about fluid.

• Fluids, steadily. Water, oral rehydration solution, coconut water, rice water, soup, buttermilk. Small amounts often works better than large amounts occasionally, particularly if there is nausea.
• Check urine. Passing pale urine several times a day is the simplest sign that hydration is adequate. Dark urine, or long gaps, means push more fluid.
• Rest, and no heroics. No going back to work or school while the fever lasts.
• Take the temperature twice a day and write it down with the date. A record of how many days the fever has run is genuinely useful to whoever sees the patient, and people reliably lose track.
• Keep the patient under a mosquito net or in a screened room during the illness. A mosquito that bites an infected person can carry the virus to everyone else in the house, which is how one case becomes four.

Paracetamol only

This matters more than most people realise. Use paracetamol for fever and pain, at the dose on the packet.

Do not use ibuprofen, diclofenac, aspirin, or the combination painkillers sold for body ache — these are NSAIDs, and in dengue they raise the risk of bleeding and can irritate the stomach lining at exactly the wrong moment. This is one of the most common avoidable mistakes in dengue, usually made in good faith by someone reaching for whatever worked last time they had body ache.

If you are unsure whether a tablet at home is an NSAID, bring the strip with you rather than guessing.

What a platelet count does and does not tell you

A falling platelet count is the number everyone fixates on, and it is the least useful thing to panic about in isolation.

Platelets fall in most dengue cases. That fall by itself does not decide anything — how the person actually looks and behaves matters far more. Someone with a low count who is drinking, passing urine and alert is in a very different position from someone with a higher count who is vomiting and cold to touch.

Decisions about admission are made on the warning signs above and on examination, with blood tests supporting that picture rather than replacing it. So do not chase a daily count while ignoring the person, and do not be reassured by a count that looks acceptable if the signs above are present.

When to come to hospital

Come the same day if any warning sign in the list above has appeared, if the fever has run more than three days without improving, if the patient cannot keep fluids down, or if they are simply getting worse rather than better. Come immediately, by ambulance if needed, for breathing difficulty, bleeding, cold clammy skin, or any change in consciousness.

Bring the fever record, any blood test reports you already have, and the strips of anything the patient has been taking.

Our emergency department is open and staffed at all hours, and no appointment is needed for it. For a fever that is not urgent but is not settling, an OPD appointment with general medicine — or paediatrics for a child — is the better route, and you will spend less time waiting.

Stopping the next one

The mosquito breeds in clean water, close to the house, in quantities small enough to overlook. Once a week, empty and scrub rather than just tip out:

• coolers, and the trays under them
• plant pot saucers, birdbaths, pet bowls
• buckets, drums and any stored water — cover it
• tyres, broken pots, plastic sheeting and anything on a terrace or balcony that holds rainwater

Scrubbing matters because the eggs stick to the sides and survive being emptied. Add daytime protection — repellent, full sleeves, screens — and treat one case in the house as a reason to check the whole neighbourhood's water, since the mosquito does not travel far.