DENGUE FEVER PROFORMA
Revised: October 2022
Patient’s Information
Patient’s Name: ___________________________ Father’s Name: ____________________________________
Age: ____________________________________ Contact No: ______________________________________
Address: ___________________________________________________________________________________
CNIC No:
Date of Admission
Hospital Reg No:
Dengue Patient Diagnosis Algorithm
Fill in “DEAG Form O/R”
Send Confirmatory Test for Dengue and
manage accordingly
Fever < 5 days
Fever > 5 days
IgM
NS1
‐
+
+
Dengue Fever
After 24 hours
Repeat NS1 and
get IgM
‐
If Dengue suspicion is still High then After
48 hours Repeat IgM and get IgG
Fill in Appropriate
DEAG FORMS
If ‐ve Repeat IgG
after 48 hours
Monitoring as per DEAG Guidelines
If all above are ‐ve,
Consider Non‐Dengue
Plasma Leak
Fill in
“DEAG DF Form – 2”
(48 hours data)
No Plasma Leak
Discharge according to
“DEAG Discharge Criteria”
Revised
October, 2022
Attach cardiac monitor to patient
Monitor: BP, PP, HR & RR
Fluid resuscitation with isotonic crystalloid 10 ml/kg over 1 hour
(500ml in adult of 50kg or above)
Repeat second bolus of 10ml/kg if no improvement with
previous bolus
Send Baseline CBC, HCT, LFTs, S.Alb, B. Urea, S. Creatinine, NA+ K+ Ca++, ABG/VBG, Glucose, Blood Grouping & Cross Match
Continue with fluid management
while awaiting HCT result
Consider
Acidosis
Bleeding
Hypocalcemia
Hypoglycemia
Myocarditis
Acidosis
Bleeding
Hypocalcemia
Hypoglycemia
Myocarditis
Send
ABGS
CBC
S.Calcium
Blood Glucose
ECG
NaHCO3 - 1ml/kg (max 10ml) diluted in equal volume of
Saline in a slow infusion
PCV - 5ml/kg or whole blood - 10ml/kg
10% calcium gluconate - 1ml/kg (max 10ml) diluted in
equal volume of Saline in a slow infusion
IV Dextrose 10%
Consider inotropic support
Administer Colloid Infusion
10ml/kg over 1 hour
Maximum
ALGORITHM FOR THE DECLARATION OF DENGUE DEATH IN
HOSPITAL
Date & Time of Admission: ____________________ Date and Time of Death: _____________________
DEAG Forms filled properly: _____________________________________________________________
First Step: Initial review
 Platelet count less than 150,000 + Fever + Clinical Symptoms (Two (02) or more symptoms)
Severe backache or joint pains
Severe headache
Rash on body
Retroorbital pain
Bleeding from nose, gums, cough, vomiting Severe muscular pain
Severe stomachache
Decreased urine frequency in children
Second Step: Diagnosis Confirmed: _______________________________________________________
 NS1/PCR with date: ______________________________________________________________
 Dengue IGM with date: __________________________________________________________
Third Step: Results of following tests if performed
1: CBC,
2: LFT,
3: RFTs,
4: VBG/ABG
4: Ultrasound abdomen,
5: Chest X‐ray.
Fourth Step: Additional Information regarding Co‐Morbidities.
1. ____________________________________________________________________________
2. ____________________________________________________________________________
Fifth Step: Management of patient
 Monitored and managed as per DEAG guidelines for Signs of Plasma Leak








Narrowing of pulse pressure < 20 mm ________________________________________
CRFT > 2 secs ____________________________________________________________
Tender hepatomegaly (DHF likely) ___________________________________________
No Urine output over the last 6 hours _________________________________________
Amount of fluids infused: _________________________________________________________
Dextran used or not and Amount: __________________________________________________
Causes of refractory shock sought or not: Acidosis, Bleeding, Hypocalcemia, Hypoglycemia,
Myocarditis, Addisonian crisis: _____________________________________________________
Blood transfused or not: __________________________________________________________
Sixth Step: Seen by consultant or not: ______________________________________________________
Final Step: Cause of Death:
1: Due to Complication of Dengue_______________________________
2: Due to Co morbidity ________________________________________
Comments by mortality review Committee: ________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Mortality Review completed by:
1: _________________________________________
2: _________________________________________
3: _________________________________________
Hospital: __________________
__________________________
Date/Time: ________________
Revised: October 2022
Patient Name/Age/Gender: ______________________________________________________________