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Dengue Shock Syndrome Symptoms and Treatment

Medically reviewed by Ika Villanueva Caperonce, MD · Infectious Disease · Makati Medical Center

Written by Hazel Caingcoy · Updated Sep 01, 2022

    Dengue Shock Syndrome Symptoms and Treatment

    Dengue is a common mosquito-borne disease. In some cases, dengue progresses and becomes fatal. Dengue shock syndrome, also known as severe dengue or dengue hemorrhagic fever, is a complication of dengue that causes hemorrhaging or bleeding inside the body. However, as of 2009, these terms have been replaced with a newer classification. Here are the dengue shock syndrome symptoms and treatments.

    Types of Dengue

    Currently, dengue is classified into three types:

  • Dengue without warning signs
  • Dengue with warning signs
  • Severe Dengue
  • In patients with dengue that manifest without warning signs, the most typical symptoms are:

    • Fever
    • Nausea
    • Vomiting
    • Headache or pain behind the eyes
    • Muscle or joint pain
    • Rashes

    There is no specific treatment for dengue but adequate hydration and supportive medication for fever and pain, like paracetamol, are helpful.

    Dengue Shock Syndrome Symptoms and Treatment: What To Watch Out For

    If the immune system can no longer fight off the dengue virus and stop it from replicating, the virus spreads throughout the bloodstream and into the organs. The virus then causes the cells of the organs to become permeable, which results in fluid leaking out of the organs.

    During the time when the fevers stop (typically around 3-7 days after the illness began), the person with dengue enters the critical phase.  This is the period wherein the virus causes the blood vessels to be more permeable which causes fluids to leak out causing shock and organ damage. Bleeding can also occur. This phase usually lasts 24-48 hours.

    Signs that a person might be having severe dengue are:


    • Unstable blood pressure
    • Skin becomes cool
    • Rapid weak pulse or very fast or very faint heartbeat
    • Blue discoloration of the lips or around the mouth (circumoral cyanosis)

    Fluid accumulation

    • Breathing rate may speed up or be more difficult

    Profuse bleeding

    • This is to be determined by a doctor and does not include self-limiting bleeding of the gums or nose.

    Impaired consciousness

    • This may be due to blood loss, high fever, or dehydration.
    • Mood changes like irritability and confusion may occur before loss of consciousness.

    Organ damage

    • Abdominal pain can be an indicator of liver involvement.

    At this point, if the person does not receive proper treatment, their illness will likely worsen and become life-threatening in the next few days.

    Symptoms of severe dengue also include:

    • Severe pain in the stomach or abdomen
    • Vomiting, frequently or with blood
    • Restlessness
    • Feeling weak and tired
    • Breathing rapidly
    • Nosebleeds (epistaxis)
    • Bleeding in the gums
    • Bleeding under the skin
    • Vaginal bleeding and intracranial bleeding in severe cases

    When a patient starts to bleed a lot within the body, this can further aggravate the fluid leakage and shock. Following this, the organs no longer receive oxygen. Multiple organs may stop functioning properly, which can result in death.

    Dengue Shock Syndrome Symptoms and Management: What To Expect

    The severity of dengue varies from one patient to another. When a person starts manifesting with warning signs, they must be admitted and closely monitored.  When signs and symptoms of severe dengue are present, they should be immediately brought to the emergency room.

    Hospital Treatment

    Once the person arrives at the hospital, medical professionals will take the necessary steps to address dengue shock syndrome symptoms. These include:

    • Immediate replacement of plasma loss. When a person
    has severe dengue, the major abnormality seen in the patient is the leakage of plasma from the cells of the body. When this happens, medical professionals will carefully administer fluids intravenously to help correct this problem
  • Continued monitoring. Plasma loss may continue for 24-48 hrs. Your doctors will carefully balance the fluids they are giving and will continue monitoring your status bloodworks and platelet levels. Plasma replacement is discontinued once vital signs are stable, there is good urine flow, and laboratory results indicate normality. Return of the person’s appetite is also a good indication that they are recovering.
  • Oxygen Therapy. When the patient is in shock or when blood pressure is too low for a period of time, medical professionals will administer oxygen to prevent organ damage.
  • Platelet Transfusion. Platelets are the component in the blood that stops bleeding. Depending on your clinical status, the presence of significant bleeding or the trend in your platelet levels, your physician might advise platelet transfusion.
  • Key Takeaway

    Dengue can become severe and progress to bleeding, shock, and possibly death. Dengue shock syndrome involves bleeding in the organs, which may eventually lead to multiple organ dysfunction. At this stage, it is extremely important to seek emergency medical treatment as home remedies are not enough to address severe dengue.

    Learn more about Infectious Diseases here.


    Hello Health Group does not provide medical advice, diagnosis or treatment.

    Medically reviewed by

    Ika Villanueva Caperonce, MD

    Infectious Disease · Makati Medical Center

    Written by Hazel Caingcoy · Updated Sep 01, 2022

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