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8. Viral diseases
– a sud d en d ro p in h aem ato crit w ith o ut clinical im p ro vem ent is a sign o f
h aem o rrh age ( o ften gastro intestinal o r internal) : transfuse fresh blo o d , 1 0 to
2 0 m l/ k g (ensure screening fo r H I V , hep atitis B and C etc.).
• C o ntinue to m o nito r vital signs every 1 5 to 3 0 m inutes and ch eck h aem ato crit
every 2 h o urs fo r th e first 6 h o urs th en every 4 h o urs. M o nito r clo sely fo r th e
fo llo wing 4 8 ho urs as sho ck m ay recur.
• S to p th e infusio ns o nce th e vital signs are no rm al and stable, th e p atient h as
regained ap p etite and the haem ato crit is no rm alised , usually 4 8 ho urs after sho ck .
Warning: m o nito r fo r fluid o verlo ad . P uffy ey elid s are the first sign o f fluid o verlo ad .
S to p the infusio n until the p uffiness d isap p ears. I n the event o f p ulm o nary o ed em a
( lary ngeal crack les, d y sp no ea, increased resp irato ry rate, co ugh w ith o r with o ut
fro thy exp ecto rant, anxiety , crep itatio ns in bo th lung field s o r tachy card ia), give:
furosemide IV , to be rep eated after 1 to 2 ho urs if necessary :
C hild ren: 1 m g/ k g/ injectio n
A d ults: 4 0 m g/ injectio n
• In an infant with a febrile seiz ure: see Seizures, p age 2 3 .
Prevention
– In end em ic areas an ep id em ic risk exists: rep o rt p ro bable o r co nfirm ed cases.
– Ind ivid ual p ro tectio n: m o squito nets and rep ellents.
– V ecto r co ntro l is essential, p articularly d uring ep id em ics: d estructio n o f larval
habitats, insecticid e sp ray ing.
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203
– a sud d en d ro p in h aem ato crit w ith o ut clinical im p ro vem ent is a sign o f
h aem o rrh age ( o ften gastro intestinal o r internal) : transfuse fresh blo o d , 1 0 to
2 0 m l/ k g (ensure screening fo r H I V , hep atitis B and C etc.).
• C o ntinue to m o nito r vital signs every 1 5 to 3 0 m inutes and ch eck h aem ato crit
every 2 h o urs fo r th e first 6 h o urs th en every 4 h o urs. M o nito r clo sely fo r th e
fo llo wing 4 8 ho urs as sho ck m ay recur.
• S to p th e infusio ns o nce th e vital signs are no rm al and stable, th e p atient h as
regained ap p etite and the haem ato crit is no rm alised , usually 4 8 ho urs after sho ck .
Warning: m o nito r fo r fluid o verlo ad . P uffy ey elid s are the first sign o f fluid o verlo ad .
S to p the infusio n until the p uffiness d isap p ears. I n the event o f p ulm o nary o ed em a
( lary ngeal crack les, d y sp no ea, increased resp irato ry rate, co ugh w ith o r with o ut
fro thy exp ecto rant, anxiety , crep itatio ns in bo th lung field s o r tachy card ia), give:
furosemide IV , to be rep eated after 1 to 2 ho urs if necessary :
C hild ren: 1 m g/ k g/ injectio n
A d ults: 4 0 m g/ injectio n
• In an infant with a febrile seiz ure: see Seizures, p age 2 3 .
Prevention
– In end em ic areas an ep id em ic risk exists: rep o rt p ro bable o r co nfirm ed cases.
– Ind ivid ual p ro tectio n: m o squito nets and rep ellents.
– V ecto r co ntro l is essential, p articularly d uring ep id em ics: d estructio n o f larval
habitats, insecticid e sp ray ing.
8
203
