A report describes a case of a 38 years old male who presented with complaints of fever five days back, cough with expectoration of sputum from the past four days. He also reported nausea, 6-7 episodes of loose stools, burning micturition, diffuse abdominal pain, and discomfort from the past three days.

Physical examination revealed him conscious, oriented, and afebrile. He demonstrated hypotension (BP: 90/60 mm Hg), oxygen saturation as 98%, pulse rate of 90beats/ min, respiratory rate of 22 breaths/min, and temperature of 94.5°F. 

Systemic examination revealed diffuse abdominal tenderness with bowel sound; and normal CVS, CNS, and respiratory system. He received Ringer lactate 500ml (150ml/hr), Inj. Noradrenalin (15ml), Inj. Pantoprazole (40mg), Inj. Ondansetron (4mg), Inj. Hydrocortisone (100mg), Inj. Isopar (1g) immediately on flow.

He received a second dose of Inj. Noradrenalin 15ml 30 min after the first dose, followed by two more doses with the same time interval and reduction to 1ml for another two doses with the same time interval. He received a total of 6 doses of Inj. Noradrenalin as a first-line therapy to improve BP, Intravenous infusion of Ringer lactate 150ml/hr was on flow; additionally, he received Inj. Meropenam (1g) and Inj. Tramadol (50mg) intravenously every 8 hr. He stopped receiving Noradrenalin with 140/90 blood pressure. His urine was drained out via Catheterization from the bladder. 

His laboratory reports revealed decreased platelet count, increased packed cell volume, increased RBC, increased Haemoglobin, ′O′ positive blood group and rheumatoid factor (RH) type, increased blood urea, increased SGOT, increased SGPT, total protein, serum albumin, positive urine albumin, and NS1 antigen. 

CT chest report showed bilateral pleural effusion, a few linear atelectasis in the right lower lobe, and two small peripheral nodules in the left lower lateral basal segment. 

CT-abdomen revealed acute enlarged pancreas, mild diffuse gall bladder wall thickening, mild central periportal edema, mild ascites, and bilateral moderate pleural effusion. 

The patient thus received the diagnosis of Dengue shock syndrome. On day two patient demonstrated stable vital and received Inj. Albumin 20ml/hr on flow, Inj. Cysteine (1gm) intravenously every 8 hr, along with other drugs from day 1. He also received two units of platelet transfusion on day-2 3 and 4. 

On day 3, the patient received Inj. Refervit 1 amp in 100 ml of normal saline once a day, with other drugs from day 2. On day four, he received an additional Inj. Texakind 500mg IV every 8 hr. On day five, he shifted from NPO to a liquid diet. He complained of Malena and thus was continued on day-4 treatment. On day 6, his catheter was removed, and On day seven, he was switched from NPO liquid diet to a soft diet, along with discontinuation of all day-6 drugs. He received Tab. Pantoprazole 40 mg (BD), Tab. Enzar forte (BD), T. Emset 4 mg (BD) from day seven onwards. 

On day nine, the patient received a discharge with Tab. Enzar forte 650mg (BD), T. Sompraz 40mg (BD) for seven days and was scheduled for a follow-up five days hence.

Nirojini PS, Durga V, Dixcy SD, Bharathi J, Asifa Shaz A, Anjana AG. Dengue Shock Syndrome - A Case Report. Indian Journal of Pharmacy Practice. 2022;15(4). DOI: 10.5530/ijopp.15.4.57