Doctors, Dengue Fever and Glutathione

The Evidence Based Medicine Protocols for Treating Those Refusing Blood Transfusions

This section, Doctors, Dengue Fever and Glutathione is for doctors treating bloodless patients and especially if presented with a patient and having limited resources.

The below protocols have been modified from the WHO Dengue Fever treatment guidelines to make them more appropriate for a patient seeking transfusion alternatives.

Here are some suggestions on protocols for treating Dengue fever in a patient who will refuse a blood transfusion.

• Antibody titer for dengue virus types
• Serology studies for antibodies to dengue viruses
• Complete blood count (CBC)
• Also you can determine diagnosis of DHF by serial platelet and hematocrit determinations, drop in platelets and rise in hematocrits. If an active bleed is noted or in DHF, specifically order micro sampling.
• Dengue fever/Dengue Haemorrhagic Fever (DF/DHF) patients should be observed hourly.
• Use intravenous isotonic crystalloids to prevent shock and/or lessen its severity.
• If the condition worsens even with 20ml/kg/hr for one hour of IV fluids, replace crystalloid with colloid solution such as Dextran. Upon improvement, replace with crystalloid.
• On improvement with crystalloids, titrate infusion from 20 ml to 10 ml to 6 ml and to 3 ml/kg.
• If hematocrit falls, in the bloodless patient, start blood enhancing treatment protocols. To improve production of blood, start giving the precursors of glutathione. Give 1 table spoon of Black Strap Molasses (un-sulfured if sulfa allergy present) mixed with one table spoon of peanut butter three times a day. Two hours before or after, give bonded whey protein isolate or N-Acetylcysteine (NAC), vitamin C, Alpha lipolic acid. Milk Thistle, and any oil, preferably Flax seed oil. Also B complex or at least B 6, B9, B12.
• If oral vitamin C therapy is considered, it is necessary to use mega-doses. This starts at 6,000 mg daily. Since the absorption is limited, many clinicians choose to have it taken hourly. Once gut intolerance is attained, diarrhea will be experienced. It is necessary to back off until the diarrhea subsides. Some have taken doses as high as 20,000 mg daily without any adverse side effects when combating illnesses. There is considerable medical literature on using vitamin C in this way. Many of the myths against C have been debunked as it is the only vitamin that is safe to take in large quantities.
• In case of severe bleeding, in the hospital, consider Aminocaproic Acid (Archives of Internal Medicene, Sept. 1989,pp 1959-61,Vol.149, No. 9 ) Page 1961: "In this study, responses to aminocaproic acid therapy were clinically dramatic. Once therapy with aminocaproic acid was initiated, platelet transfusions were no longer necessary in the majority of our patients."
• A half hammersmith of Aprotinin. Once platelets are stabilized... Then give crystalloid at 10 ml/kg/hr for a short time (30-60 minutes) and then titrate to a slower infusion rate. (would this be appropriate?)
• If signs of shock, give oxygen 2 lpm via nasal cannula.
• For correction of acidosis (sign: deep breathing), use sodium bicarbonate or baking soda.

Not recommended for children under 5. Adult dosage, ½ teaspoon dissolved completely in 4 ounces (½ cup) of water, preferably filtered and chlorine free. Do not take more than seven times in 24 hours. If over 60, do not take more than three times in 24 hours. Do not use for more than 7 days.

• Recombinant activated factor V11 has also been used to control bleeding in patients with Dengue Shock Syndrome.

Do Not...

• Do not give Aspirin or Bufferin for treatment of fever (risk of Ryes Syndrome).
• Avoid starting IV therapy if no evidence of hemorrhage and bleeding.
• Avoid using steroids. There is no evidence that they provide any benefit.
• Do not use antibiotics, especially when febrile. No evidence that they work.
• Avoid rapidly increase or decrease in rate of IV fluid administration.
• Do not use nasogastric tube to determine or stop bleeding (it is contraindicated).

Recovery Signs and Symptoms

• Pulse, blood pressure and breathing rate should stabilize
• Temperature should normalize
• No signs or symptoms of external or internal bleeding
• Normal appetite should return
• Nausea or vomiting should have ended
• Urine output will be normal
• Hemoglobin and Hematocrit will be stabilized

Discharge Criteria

• Afebrile for at least 24 hours without the use of anti-fever therapy
• Appetite returns to normal
• Overall visible improvement
• Urine output improved
• In cases of shock, follow recovery protocols, usually three days
• Absence of respiratory distress
• No plural effusion and no ascites
• Platelet count greater than 50,000/mm3

About Jonathan Steele, RN, Dengue Fever and Glutathione

Jonathan Steele experience ranges from hospital nursing, high tech pediatric, bloodless medicine and surgery, hospice, pain management, wound healing specialist, and photo-bio-modulation (LLLT) therapist. Within all of these specialties, glutathione as a means to reduce pain, increase healing potential, boost blood counts and improve overall health and quality of life.

Because water an electrolyte balance is key to boosting GSH, he has added hydration coach to his skills. You can learn more about hydration at WaterCures.org He is currently working as a holistic nurse.

Because of the increase risk of tropical diseases among those traveling to third world countries, his practice has included holistic management of these diseases.

Many North American Doctors, not familiar with tropical diseases have made recommendations contrary to the WHO guidelines for treatment of diseases such as Dengue Fever. The Doctors, Dengue Fever and Glutathione page was created in part to help provide a resource for patients to become educated consumers. For doctors who are combining holistic health with modern health care, we are providing the evidence based medicine to help you make your decisions.

Can you help us refine our protocols? Please offer your suggestions below.

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