A trail of illness and death is what dengue has left behind while continuing to strike down men, women and children in an uncontrollable spree sending fear into the hearts of all.
A child here, a young mother there, an office worker or a professional elsewhere…..no one is spared by this tiny mosquito.
Everyone is vulnerable and prevention is the best way out, stresses Consultant Paediatrician Dr. Pushpa Punchihewa of the Lady Ridgeway Hospital For Children, taking a moment off from treating 92 little patients, to explain that if Sri Lanka could end the 30-year war, control malaria, eradicate polio and almost eradicate measles, we could fight the scourge of dengue and win.
Dealing with the basics of how to handle a dengue patient, Dr. Punchihewa urges parents to be watchful. If a child continues to have a fever for more than two days, suspect it is dengue and on the third day take the child to an experienced paediatrician or the closest state hospital.
Don’t wait, she stresses, for time is of essence.
Day 3 of a fever is crucial, MediScene understands, not only for a child but also for an adult who too should seek medical help immediately.
The doctor will then order a blood test. Make sure to go back to him/her as soon as the results are available for the findings to be evaluated, says Dr. Punchihewa.
Dispelling a strongly held belief that dengue deaths occur due to a low platelet count, she underlines the fact that another crucial count that needs to be monitored is the Packed Cell Volume (PCV) or in lay terms the “thickness of the blood”.
Why is the thickness of blood of vital importance?
This Paediatrician answers this with another question: What is the job or work of blood?
The most important role of blood is to circulate or move through the circulatory system feeding and nourishing with oxygen and nutrients the whole body including vital organs such as the brain, the kidneys and the liver. “If these vital organs don’t get oxygen and nutrition, they die.”
Between the 3rd and the 7th day of dengue the danger lies in the fact that plasma could leak out of the circulatory system into the spaces of the body such as the lung cavity and the abdomen, making the blood too thick, causing a rise in the PCV and hindering the movement of blood. This compromises the supply of oxygen and nutrition to the vital organs.
That's why a close eye has to be kept on the PCV, it is learnt.
Dr. Punchihewa draws a comparison to spilling water on the floor. The moment you spill the water, it will spread easily because it is not thick but what happens if it is thick cunjee. It will not move or spread out but be at the same spot.
It is very important to catch the point of plasma leakage, if not the circulatory system will collapse and the patient will go into shock. “Then it is a little too late,” says Dr. Punchihewa. Due to a rise in PCV, when oxygen does not go to the system, the organs will shut down. The liver which is anyway affected by dengue will get damaged further.
Even if the platelets are down to 20,000 (usually they should be more than 150,000) if the plasma or PCV is okay, there is nothing to worry, if the clinical signs such as the pulse are stable, according to Dr. Punchihewa. Usually a weak pulse and clammy (cold) hands and feet will indicate that a patient is going into shock.
She gives a word of warning about the amount of fluid a person should take. When a person is having fever it is important to take adequate liquids by mouth to be well-hydrated.
The same applies if tests show that the PCV is high – this is the warning sign for the patient to be given liquids by mouth as well as intravenously to prevent the patient going into shock. But the PCV has to be monitored every 2-4 hours for as soon as the PCV starts coming down the liquid intake should be stopped. Otherwise the fluid that may have leaked will be re-absorbed, she says.
High fever won’t kill
but drugs can
Don’t worry about bringing down a fever, stresses Dr. Punchihewa, pointing out that the “fever phobia” of Sri Lankans could also lead to children being overdosed with paracetamol and other medication including ibuprofen or the insertion of diclofenac sodium suppositories which could cause serious bleeding and death if it is dengue.
Fever may cause a seizure (fit), that also only in children younger than five years, but fits will not kill. However, drugs can kill. So don’t be overly concerned about bringing down the fever at any cost, because that may do more harm than good, she adds.