He is suffering from DHF – grade 2

Initiate iv therapy 6 ml/kg/h NS or RL for 1-2 hour = 360 ml/h

Check Hct

 

Improvement - Hct falls, pulse rate and blood pressure stable, urine output rises - >IV therapy by crystalloid successively reducing the flow from 6 ml/kg/h for 2-4 h to 3 ml/kg/h for 2-4 h and 3-1.5 ml/kg/h for 2-4 h - >Further improvement - Discontinue IV after 24-48 h

 

No improvement: Hct or pulse rate rises, pulse pressure falls below 20 mmHg, and urine output falls

Hct rises - >Increase IV - 10 ml/kg/h crystalloid for 2 h

Hct falls - >Suspect internal haemorrage -> Blood transfusion (10 ml/kg whole blood)/ (5 ml/kg packed RBC)->Improvement->IV therapy by crystalloid successively reducing the flow from 10 to 6 and later 6 to 3 ml/kg/h. Discontinue after 24-48 hrs.

Indications for blood transfusion- 

1.       Loss of > 10 % of blood volume

2.       Refractory shock despite adequate hydration

3.       Declining hematocrit