Last Updated on August 19, 2026
Warning signs
• Lethargy, restlessness ≥2 episodes of vomiting that amounts to fatigue / requires intravenous fluids bleeding from nose, gums, conjunctiva, vagina, gastrointestinal / respiratory / urinary tract Haematocrit ↑ 20% from baseline value with concurrent platelet count ≤ 100
• Abdominal pain — abdominal tenderness & NOT intermittent pain pain
• Clinical fluid accumulation — pleural effusion / ascites
• Liver enlargement >2 cm
•
Persistent vomiting
•
Mucosal bleed
• Laboratory findings:
↑ haematocrit with concurrent ↓ platelet
Severity of shock
Normal Circulation | Compensated Shock | Decompensated / Hypotensive Shock | |
Consciousness level | Clear & alert | Clear (may be missed if you do not touch patient) | Change of mental state - restless / drowsy |
Temperature of extremities | Warm & pink | Cold | Cold clammy extremities |
Capillary refill time (CRT) | Brisk (<2 seconds) | Prolonged (>2 seconds) | Mottled skin, very prolonged CRT |
Peripheral pulse volume | Good volume | Weak & thready pulses | Feeble / Absent |
Heart rate | Normal | Tachycardia | Severe tachycardia // bradycardia in late shock |
Blood pressure | Normal | - Normal
SBP
Abbreviation: SBP • Systolic blood pressure • Spontaneous bacterial peritonitis Abbreviation: DBP • Diastolic blood pressure -
Postural hypotension
Postural hypotension: https://www.myhouseman.my/hypotension/ | Hypotension / Unrecordable BP |
Pulse pressure | Normal | Narrowing pulse pressure | Narrowed (≤20 mmHg) / Unrecordable |
Respiratory rate | Normal | Tachypnoea | Metabolic acidosis / Hypernoea |
Urine output | Normal | Reducing trend | Oliguria / Anuria |
CPG
CPG Management of Dengue in Children (2nd ed, 2020)
Take Home Message
1. Child must be touch touched, or else parameters of shock will be missed e.g. cold extremities, weak peripheral pulses, prolonged CRT