| Good clinical practice | Bad clinical practice |
1 | Assessment and follow-up of patients with non-severe dengue and careful instruction of warning signs to watch out for | Sending patients with non-severe dengue home with no follow-up and inadequate instructions |
2 | Administration of paracetamol for high fever if the patient is uncomfortable | Administration of acetylsalicylic acid (aspirin) or ibuprofen |
3 | Obtaining a hematocrit level before and after fluid boluses | Not knowing when hematocrit levels are taken with respect to fluid therapy |
4 | Clinical assessment of the hemodynamic status before and after each fluid bolus | No clinical assessment of patient with respect to fluid therapy |
5 | Interpretation of hematocrit levels in the context of fluid administered and hemodynamic assessment | Interpretation of hematocrit levels independent of clinical status |
6 | Administration of intravenous fluids for repeated vomiting or a high or rapidly rising hematocrit | Administration of intravenous fluids to any patient with non-severe dengue |
7 | Use of isotonic intravenous fluids for severe dengue | Use of hypotonic intravenous fluids for severe dengue |
8 | Giving intravenous fluid volume just sufficient to maintain effective circulation during the period of plasma leakage for severe dengue | Excessive or prolonged intravenous fluid administration for severe dengue |
9 | Avoiding intramuscular injections in dengue patients | Giving intramuscular injections to dengue patients |
10 | Intravenous fluid rate and frequency of monitoring and hematocrit measurement adjusted according to the patient’s condition | Fixed intravenous fluid rate and unchanged frequency of monitoring and hematocrit measurement during entire hospitalization for severe dengue |
11 | Close monitoring of blood glucose, i.e. tight glycemic control | Not monitoring blood glucose, unaware of the hyperglycemic effect on osmotic diuresis and confounding hypervolemia |
12 | Discontinuation or reducing fluid therapy once hemodynamic status stabilizes | Continuation and no review of intravenous fluid therapy once hemodynamic status stabilizes |