Integrating structured point-of-care ultrasound into dengue fever management: A mini review and comprehensive clinical guide

Table 3 Common clinical scenarios in dengue fever and corresponding management strategies

Issues	Lung scan (step 1)	Free fluid (step 2)	Gallbladder (step 3)	IVC (step 4)	ECHO (step 5)	Hematocrit	Lactate	Management options (according to local guidelines)
Dehydration	Normal	No	Normal	< 2.1 cm Collapsibility > 50%	Normal	Normal or raised	Normal	Hydration (0.5-5 mL/kg/hour)
Plasma leakage (early)	Normal	Yes	Thickened	< 2.1 cm Collapsibility > 50%	Normal	Raised	Normal	Hydration (5-20 mL/kg/hour)
Plasma leakage (late)	Interstitial edema	Yes	Thickened	< 2.1 cm Collapsibility > 50%	Pericardial effusion	Raised	Raised	Hydration (5-20 mL/kg/hour)
Bleeding	Normal or interstitial edema	Yes	Normal or thickened	< 2.1cm Collapsibility varies	Normal	Reducing	Raised	Blood product transfusion
Reabsorption with systemic congestion	Interstitial edema	Yes	Normal or thickened	≥ 2.1cm Collapsibility < 50%	Normal	Varies	Normal	Stop hydration (consider diuresis)
Dengue cardiomyopathy/myocarditis	Interstitial edema	Yes	Normal or thickened	≥ 2.1cm Collapsibility < 50%	Reduced LVEF	Varies	Varies	Judicious hydration
Preexisting heart failure or renal failure	Interstitial edema	Varies	Varies	≥ 2.1cm Collapsibility varies	Reduced LVEF	Varies	Varies	Judicious hydration (consider diuresis)
Preexisting liver cirrhosis or nephrotic syndrome with hypoalbuminemia	Interstitial edema	Varies	Varies	< 2.1 cm Collapsibility > 50%	Normal	Varies	Varies	Hydration with colloid

IVC: Inferior vena cava; ECHO: Echocardiography; LVEF: Left ventricular ejection fraction.