I am a doctor, and I tell patients not to celebrate when dengue fever drops

Most people think dengue is only about fever and low platelets, but the biggest danger often begins when the fever starts coming down. As an internal medicine specialist, I want everyone to know what truly matters during dengue treatment.

In Short

• The riskiest stage often begins when the fever starts settling
• Doctors watch platelets, haematocrit, blood pressure and pulse during monitoring
• Water and oral rehydration help mild cases avoid dangerous dehydration

Editor’s Note: In this fortnightly column, top doctors share how they deal with their own health challenges, offering readers expert insight grounded in experience. Read more such stories here.

Dengue cases increase every year during the monsoon season, and with every outbreak, I see the same questions from patients and their families. "Is there a medicine that kills the dengue virus?" "Should we panic if platelets start falling?" "When should we go to the hospital?"

The biggest misconception is that dengue has a specific cure. The truth is that there is no targeted antiviral medicine available for dengue. Treatment is entirely supportive, which means our goal is to help the body recover safely while preventing dangerous complications.

The good news is that most dengue patients recover completely with proper medical care. The key is recognising warning signs early, staying well hydrated, and avoiding common mistakes that can make the illness worse. In my experience, timely treatment and close monitoring can make all the difference between a smooth recovery and a medical emergency.

Here are the most important things everyone should know about dengue treatment.

1. THE MOST DANGEROUS PHASE OFTEN STARTS WHEN THE FEVER COMES DOWN

Many people believe they are getting better once the fever disappears. Unfortunately, this is often when dengue enters its most critical stage.

Around the third to fifth day of illness, especially when the fever starts settling, patients need careful monitoring. This is the period when complications such as plasma leakage, bleeding, or shock may develop.

That is why I recommend regular clinical evaluations during this phase. Doctors usually monitor platelet counts, hematocrit levels, blood pressure, pulse rate, and overall clinical condition. If the patient remains stable and has no warning signs, recovery at home is often possible, provided the family understands when immediate medical attention is needed.

2. FLUIDS ARE THE MOST IMPORTANT TREATMENT

Since no medicine directly kills the dengue virus, proper hydration becomes one of the most effective treatments.

Patients with mild dengue should drink plenty of fluids, including water and oral rehydration solutions, to prevent dehydration.

However, if warning signs appear or the patient is unable to drink enough because of vomiting or weakness, intravenous fluids become necessary. Fluids such as normal saline or Ringer's lactate are commonly used in hospitals.

It is equally important not to give excessive fluids. Too much intravenous fluid can lead to complications such as fluid accumulation in the lungs, making breathing difficult. Doctors carefully calculate the amount of fluid required and monitor urine output, blood pressure, and other vital signs throughout treatment.

In most patients, intravenous fluids are only needed during the critical 24 to 48-hour period.

3. NOT EVERY FEVER MEDICINE IS SAFE

One of the biggest mistakes I see is people taking painkillers like ibuprofen or aspirin without consulting a doctor.

For dengue patients, paracetamol (acetaminophen) is the safest choice for controlling fever and body pain.

Medicines such as ibuprofen, aspirin, diclofenac, and many other NSAIDs should generally be avoided because they increase the risk of bleeding, which is already a concern in dengue infection.

Similarly, steroids are not routinely recommended unless there is another medical condition that specifically requires them.

If you are unsure about any medicine, always consult your treating doctor instead of self-medicating.

4. KNOW WHEN HOME CARE IS NO LONGER ENOUGH

Not every dengue patient needs hospital admission, but some people require closer observation.

Hospital care becomes necessary if warning signs develop, including persistent vomiting, severe abdominal pain, bleeding, excessive weakness, difficulty breathing, or reduced urine output.

Certain groups are also at higher risk of complications. These include pregnant women, infants, elderly individuals, people with diabetes, heart disease, or other chronic illnesses.

Patients who cannot drink enough fluids or who do not have proper monitoring available at home should also be admitted for observation and treatment.

Early admission in high-risk patients can prevent life-threatening complications.

5. EARLY TESTING HELPS CONFIRM THE DIAGNOSIS

Several tests help doctors diagnose dengue depending on how many days have passed since symptoms began.

The NS1 antigen test is most useful during the first five days of illness and can detect dengue infection early.

Later in the illness, antibody tests such as IgM and IgG become more useful. In some situations, PCR testing may also be recommended for confirmation.

Doctors may also perform a tourniquet test as part of the examination. While it can support the diagnosis, it cannot confirm dengue on its own and should always be interpreted along with symptoms and laboratory findings.

As a physician, I want people to remember one important message: there is no magic medicine for dengue, but timely supportive care saves lives.

Do not focus only on platelet numbers. Pay attention to hydration, warning signs, and regular medical follow-up, especially after the fever begins to settle.

Most dengue patients recover completely when they receive the right care at the right time. Early diagnosis, careful monitoring, appropriate fluid management, and avoiding unsafe medications remain the pillars of successful treatment.

(Dr Pankaj Khatana, Senior Consultant, Internal Medicine, Marengo Asia Hospitals Gurugram)

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