Severe abdominal pain is experienced by some individuals suffering from Dengue fever. The pain episodes last for a few hours during the day and are more common in children aged 7-14 years. There is usually no correlation with food intake. Routine administration of anti-spasmodics does not provide much relief. Based on personal experience, have any of the members found an effective or superior means of meliorating the condition?
Acetaminophéno or Paracetamol that you use for low the fever is efective, Abdominal pain is a Alarm Signal that predict the Shock.And First you need to make a good Hidratation.The etiology is Glisson capsule distensión by fluid acumulate around: Liver, gallbladder and Kidney you can make an Abdominal ECO for evidency this ( Erick Martínez PhD and Work Group IPK Cuba y Hospital Pediatrico William Soler).
As far as my experience is concern abdominal pain in severe cases of dengue haemorrhagic fever indicates hypovoaemia and constriction of splanchnic circulation. This is a serious situation and need urgent replacement of fluid.
Excúseme This is for Christopher Ndunya: Please make a Study using Zinc: 10 mg for minor of 3 years and 15 mg for 3 to 5years and All nutrients (proteins Carbohidrates and Fats plus Vitamins and Minerals) at 300% RDA and retrovirals and observe the good or bad evolution of this. Thanks.
Fluids....
Take it easy with the paracetamol, titrate opiods may help if poor control an no nausea precent (after full screening) PPI may also provide some relieve (particularly in teenagers)
Dear Indrajit: At this point, I can say that according to our clinical experience and reseacrh data from Peru ,DENV serotypes and genotypes determine differents clinical spectrum and severity. For us, DENV2 genotype american-asian, caused more abdominal pain as a symptom manifested by the patient, (febrile phase) but once the patients was in the hospital setting,and during the critical phase (non febrile phase) the presence of abdominal pain must be considered as a warning sign. In this case hydration must relief, considering the severity.
In the Hospital Regional de Loreto, Infectologysts (Dr Marin, Dr Celis, Dr Ramal) once they indicate the propper hydration according to its clinical condition, after the patient is stable, is common to indicate Metamizol IV. It helps the patients to feel better although the patient is under monitorization.
greetings
Stalin Vilcarromero, PERU
Metamizol (Novalgina) in caucasian and some etnias in Latin American cause Neutropenia and aplasic anemia not reversible, for this cause Fluids and acetaminophen is more sure.I saw this.
Dear Stalin: DENV-2 is indeed more commonly encountered in our region. Symptoms are much more profound, and the progression to severe shock is higher with DENV2. At present, we mainly concentrate on fluid management, and cases with severe abdominal pain are given antacids and antispasmodics. We have not yet started any pediatric patient on metamizol- I intend to peruse more literature on this drug. Thank you for your input.
Thank you Indrajit: In the amazon region of Peru, where dengue virus is endemic, there is large experience with Metamizol at the hospital setting. All Dengue inpatients (which includes dengue hemorrhagic cases and non DHF) we had since 2004-oct.2010 (when DENV.3 was predominant) were treated especially with fluids, antiacid and metamizol (usually TID) the first days, then we use to change to Acetaminophen. During nov2010-2011, the most severe dengue outbreak of our history occured and we started using a new dengue classification (WHO: dengue severe and with/out warning sign), and despite we had all the spectrum of severity (guillan barre, myocarditis, ARDS,etc) Metamizol did not seem not to be related to more severity, that´s the reasons we still are using Metamizol conditional to relieve fever or any pain which is not a warning sign. However, we observed some cases, when any physician indicated an antiespasmodic in order to relieve an abdominal pain (during critical phase) which was, really, a warning sign, more descompensation occured. As you can see, I am concerned about antiespasmodics while Jose Luis is concerned about Metamizol. We had not any research about it despite the high experience.
Thanks for your attention, it was an opportunity to share our experience!
SOMETIMES, we use that we have at hand or in the drug store, you can use metamizol with care, and think in the adverse reactions, I remenber that Dr. Erick Martinez used Aspirin (for the economic stop [bloqueo[), because there is not acetaminophen, and there is only ASA, and give this in his work, but in other hospital occurr bleeding, He don´t report this, Is a personal comunication when he teached Dengue to us group.
Stalin continua, no te desalientes nunca, estas en un lugar muy lejano, estas en el frente de guerra contra el Dengue y contra el mosquito AE, en la trinchera contra el Dengue, si en algo pudiera ayudarte, en alguna duda, comunícame tus inquietudes,estamos para ayudarnos todos con nuestras experiencias.He observado que el Guillen Barre se soluciona sin usar Inmunoglobulina IV igual que el Dr. Martinez, pero siempre hay que estar alerta de la Ins. Respiratoria, Ustedes han tenido una epidemia por una quimera Americano Asiática que probablemente se le escapo a Alguien que estaba experimentando con esto o el experimento se le escapo de las manos, ya que tenia que haberse hecho con un grupo que este bajo una especie de invernadero, donde no se les escapen ni los mosquitos ni los que fueron vacunados y que al ser picados por Aedes del ambiente se contaminaron los mosquitos y produjeron la epidemia,algo antietico.
Disculpen los demás colegas pero tenia que escribirlo rápido en español.
Dear Stalin: It is interesting to note that the DENV3 lasted the period of 6 years in Peru, and then shifted to DENV2. In my region of South India, the DENV2 has been predominant for a much longer time, and still continues to be the most common. Some uncommon manifestations we encountered were dengue associated nephritis, myocarditis and encephalitis.
In my experience, the intractable bouts of abdominal pain (lasting around 3-4 hours)in children were mostly observed during the evening hours, and they seemed perfectly fine in the morning. Any probable reasons for this?. I can only assume that it has to do something with the vagal tone fluctuation in the evening. Do also consider that these patients were in the PICU and with constant monitoring of BP and fluid status with appropriate titrations.
Your experience with metamizol is indeed very interesting, and I shall be actively following your experiences with combating the DENV, and am sure they will be very useful in providing optimal care to children.
Dear Jorge: Thank you for your valuable inputs. Yes, many a time we are limited by the drug availability in our pharmacies, and more so we also have to consider the affordability factor, and burden on the patient's family.
The use of ASA that you have quoted is indeed surprising and I am sure that the good Dr.Erick Martinez took a gamble there. Sometimes everything works for the good, and true good done in the patients best interest is what matters.
What has been your personal experience with metamizol?
Metamizol or Dipirona (Novalgina) is a pirazolonic drug with a bencenic ring, for this cause agranulocitosis and aplasic anemia was discontinuous the use in the USA around 1980, When I studied Medicine (1980) my Tropical Medicine Teacher said:" You can use Metamizol in patients with Typhoid Fever never I saw agranulocitosis,bla,bla,only I saw in caucasic not in Ecuadorians because we are other race,bla,bla". With a friend of school medicine search cases of neutropenia for Dipiron, find 10 patiens. After in the practice in clinics and hospitals I observed 4 patients: neutropenia and aplasic anemia asociated to metamizol, and question about this to Hematologist, they begin to search this asociation and find many patients. For this razon I stop the use of dipirone or metamizol. I don´t use this for Dengue, I prefer Fluid and Acetaminofen. In developing countries Some trasnational pharnaceutical sell garbage drugs.
Hi We used ranitidine in these children and got quiet good result during dengue epidemic 2011
I don’t have any experience in dengue, but metamizol is a drug widely used among several European (Spain, Italy, France, Germany, etc) and American (Mexico, Brazil, Argentina, Chile, etc.) countries. Moreover, I understand that metamizol is available in India and China. Because of the extremely low incidence of agranulocytosis, its association with metamizol use remains controversial.
Ibáñez L, Vidal X, Ballarín E, Laporte JR. Agranulocytosis associated with dipyrone (metamizol). Eur J Clin Pharmacol. 2005; 60(11):821-9.
Hamerschlak N, Cavalcanti AB. Neutropenia, agranulocytosis and dipyrone. Sao Paulo Med J. 2005; 123(5):247-9.
No tengo experiencia en dengue, pero el metamizol es una droga ampliamente utilizada en países europeos (España, Italia, Francia, Alemania) y Americanos (México, Brazil, Argentina, Chile, etc.). Más aún, entiendo que se encuentra disponible en India y China. Su capacidad para producir anemia aplástica es aún discutida ya que, debido a la bajísma incidencia del evento es muy difícil de demostrar.
Dear friend Farah, would you give me the follow information:What kind of virus are circulating in your country?, because in Ecuador during 2012 was circulating DEN 1, DEN 2 y DEN 4 and probablely an American Asiatic Chimeric Virus. Thank you
The onset of abdominal pain in a child with dengue may be due to simple gastritis or might herald the onset of capillary leak with its attending complications. Third space loss may lead to tender hepatomegaly and even intestinal ischemia. The pain tends to become less as the leaky phase ends and once the child starts diuresing. We have managed many children successfully with IV pantoprazole and fluid regimen recommended by WHO. It is better to avoid NSAIDS or ASA for fear of hemorrhagic complications and reye like illness. .
Yes, we see severe pain abdomen especially when they have fluid leak, hepatomegaly or g i bleed. we have used ranitidine ( it can also cause reduced platelets!)or ,pantoprazole with dicyclomine hydrochloride
( antispasmodic- helps in painful spasm / bleed) .Child gets relief only when recovery starts and diuresis commences
Dear Tammer if we are discussing about the evidence of the use of other drugs differents to acetaminofen or Paracetamol, steroids is so much controversial. I think that research about drugs we can use in dengue has stopped several years ago.
best
stalin
En los países asiáticos y en Cuba se hicieron estudios usando esteroides sin ningún buen resultado.
On Asian countries and Cuba: they did some research about use of corticoesteroids the results were not good. It´s same in Shock.
Hi Stalin, have a very good weeek, now we have much rain and low rate of mosquitoes.
I have the experience of treating many patients with Dengue in Kolkata, India.I agree that Pantoprazole or Omeprazole can help by relieving gastritis, but a word of caution is - Pain Abdomen could be because of onset of "Diving Reflex" in hypovolumic Shock and thus an ominous sign. I have seen marked relief of pain following fluid ressuscitation.
At the age of 18 years, I was diagnosed with Dengue fever while living in Puerto Rico. The only pain medication that alleviated the pain was Demerol. Various other medications were tried first, as they thought it was overkill to administer this strong of a drug to a young female weighing 95 lbs. IV fluids were administered due to dehydration caused by vomiting and tropical climate. The pain I suffered most from was an intense, constant migraine that affected my balance and vision,
Thank you Subroto Chakrabartty for revealing your treatments in patients, and explaining how "Diving Reflex" may be resolved.
We have no experience of using metamizol. However, H2 blocker/ PPI are frequently used to counter act or reduce acid pepsin activity. Intestinal ischemia may be relived by judicious fluid replacement. Perhaps steroid has no role rather it could be harmful.
Severe pain abdomen in Dengue is considered a warning sign and is due to plasma leak leading to hypovolemia . Whenever effective plasma volume shrinks vascular supply of less vital organs are cut in order to maintain circulation to Heart, Brain, Kidneys so pain abdomen in dengue can be best managed by volume replacement. WHO guidelines Class B treatment - RL Start with 5-7 ml/kg/hour for 1-2 hours, then reduce to 3-5 ml/kg/hour for 2-4 hours, and then reduce to 2-3 ml/kg/hour is to be done.
Abdominal pain in Dengue fever can be a sign of severe impending hypovolemic shock. It is related to liver microinfarts secondary. Some Dengue experts say that abdominal pain can be more worrisome than the platelet count number by itself. Other than antiacids and agressive hydration I will try to avoid pain medication for abd pain
Pain is most likely due to hypovolemia and fluid resuscitation definitely helps.