A 10-year-old girl with dengue fever presents with abdominal pain, persistent vomiting, lethargy, and a rising hematocrit of 52% (baseline 38%), indicating significant plasma leakage. Her blood pressure is normal, peripheral perfusion is adequate, and there are no features of shock. According to the WHO dengue guidelines, what is the most appropriate initial intravenous fluid rate?

A.	Ringer lactate at 3 mL/kg/hour
B.	Ringer lactate at 5 mL/kg/hour
C.	Ringer lactate at 7 mL/kg/hour
D.	Ringer lactate at 10 mL/kg/hour

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Correct Answer » C Explanation

The child has dengue with warning signs and significant hemoconcentration, indicating ongoing plasma leakage, but no shock.

According to the WHO dengue fluid management protocol:

• 5–7 mL/kg/hour is recommended initially for dengue with warning signs.
• In patients with marked plasma leakage (significantly raised hematocrit), the higher end of the recommended range (7 mL/kg/hour) is appropriate.

Why Other Options Are Incorrect

A. Ringer lactate at 3 mL/kg/hour

• Too low for a patient with warning signs and significant plasma leakage.

B. Ringer lactate at 5 mL/kg/hour

• Suitable for milder cases of dengue with warning signs.
• In this patient, the marked rise in hematocrit indicates more significant plasma leakage, making 7 mL/kg/hour the preferred initial rate.

D. Ringer lactate at 10 mL/kg/hour

• Reserved for patients with dengue shock or hypotension and is not indicated in a hemodynamically stable patient.