In a patient presenting with acute dengue fever, which clinical warning sign indicates severe vascular plasma leakage requiring urgent inpatient intravenous fluid therapy?

Answer and explanation

Correct answer: A. Persistent vomiting with severe abdominal pain

  1. Step 1: Dengue virus infection can progress during the critical defervescent phase into severe dengue characterized by plasma leakage and shock.
  2. Step 2: World Health Organization warning signs that mandate immediate hospitalization include severe abdominal pain, persistent vomiting, fluid accumulation (ascites, pleural effusion), mucosal bleeding, and rapid hematocrit rise with falling platelet count.
Answer
Persistent vomiting with severe abdominal pain.
Why not the others: Mild headache is a common feature of uncomplicated dengue fever. Defervescence is expected around days 3 to 7, but the presence of persistent vomiting and abdominal pain signals entering the critical phase. A blanching macular rash is a benign manifestation that does not indicate severe capillary leakage.

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