Dr KK’s formula of 20 for identifying at risk dengue patients

Dengue fever is now prevalent all over the world and has significant but preventable mortality. Knowing simple formulas can reduce the mortality.

The treatment of dengue is, that once the fever is over, give the patient enough fluids that he or she passes urine every 4 hours. Intravascular dehydration is the reason for mortality and not platelet deficiency. Do platelets only for diagnosis and not for follow ups.  Only monitor the pulse pressure and keep it > 20.

There is no need for platelet transfusion unless platelet count is less than 2% of the baseline value

AND there is presence of ACTIVE spontaneous bleeding.

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 The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after fever is over.  Often people insist on a discharge from the hospital when the fever is over or do not want to get admitted once the fever is over.

 Physicians should remember the Dr KK’s formula of 20 for identifying high risk patients.

1.      Rise in pulse by more than 20.

2.      Fall in upper BP by more than 20.

3.      Difference between lower and upper BP of less than 20.

4.      Platelet count less than 20 thousand.

5.      Presence of more than 20 hemorrhagic spots on the arm after tourniquet test.

6.      Rise in hematiocrit by more than 20%.

7.      Treat such patients with 20 ml/kg body weight per hour of fluid replacement till the patient passes urine and the BP is stabilized.