Clinical context
Dengue is a dynamic illness whose severity often becomes apparent only around
defervescence—the time when the fever begins to fall. For a child classified as
dengue without warning signs, home care is appropriate only when caregivers can maintain adequate oral hydration, manage fever safely, and recognize early indicators of deterioration that require immediate return to a health facility.
Why the correct measures are 1, 3, and 4
The cornerstone of home management is maintaining intravascular volume through frequent oral fluids and oral rehydration solution (ORS). Dengue causes increased capillary permeability, and even without overt plasma leakage, insensible losses from fever and reduced oral intake can rapidly deplete circulating volume. Offering small, frequent amounts of ORS—rather than large volumes at once—improves tolerance and sustains hydration during the febrile phase.
For fever control,
paracetamol is the preferred antipyretic. It reduces temperature without impairing platelet function or increasing bleeding risk. The dose must remain within the maximum daily limit because hepatic metabolism of paracetamol can be stressed during an acute viral illness, and overdosing adds a preventable risk of hepatotoxicity.
The most critical home-care instruction is to return immediately if warning signs appear, particularly abdominal pain or persistent vomiting, even as the fever subsides. Defervescence marks the transition from the febrile phase to the critical phase, when plasma leakage peaks. Abdominal pain and vomiting at this point may signal impending plasma leakage or fluid accumulation, and timely recognition can prevent progression to shock.
Why measures 2 and 5 are incorrect
Watch out! Ibuprofen and other NSAIDs are contraindicated in dengue because they inhibit platelet aggregation and irritate the gastric mucosa, increasing the risk of bleeding during a disease already characterized by thrombocytopenia and capillary fragility. Even a single dose for high fever can compound hemorrhagic risk.
Key point! Aedes aegypti and
Aedes albopictus are daytime biters, with peak activity in the early morning and late afternoon. Keeping a child under a mosquito net only at night does not prevent daytime mosquito bites. More importantly, during the viremic phase, an infected child can transmit the virus to uninfected mosquitoes that bite during the day, perpetuating the transmission cycle within the household and community.
| Home care measure | Rationale | Inclusion |
|---|
| Frequent oral fluids and ORS | Maintains intravascular volume against capillary leakage and febrile losses | Correct |
| Ibuprofen for fever over 39 °C | NSAID; increases bleeding risk via platelet inhibition and gastric irritation | Incorrect |
| Return for abdominal pain or vomiting as fever falls | Defervescence coincides with critical phase onset; warning signs demand reassessment | Correct |
| Paracetamol within maximum daily dose | Safe antipyretic that does not impair platelet function | Correct |
| Mosquito net only at night | Aedes mosquitoes bite during the day; night-only netting fails to interrupt transmission | Incorrect |
Pathophysiology link for the licensure exam
Dengue illness progresses through three overlapping phases: the
febrile phase, the
critical phase around defervescence, and the
recovery phase. The clinical decision to manage a child at home rests on the absence of warning signs and the family’s ability to recognize them. Warning signs include abdominal pain, persistent vomiting, mucosal bleeding, lethargy, restlessness, liver enlargement, and a rapid drop in platelet count with rising hematocrit.
Teaching caregivers to monitor for these signs—especially during the first 24 to 48 hours after fever subsides—is as important as the fluid and antipyretic instructions themselves.