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