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‘If you have fever, body aches do not take NSAIDs’
View(s):It could be dengue, and the consequences would be disastrous, warns expert
By Kumudini Hettiarachchi
“Do not dose those who are down with fever and body aches with common pain-relieving medications and don’t pop them if you are having these symptoms.”
Dr. LakKumar Fernando
If there is fever and body aches, the first suspect should be dengue and prescribing or popping common pain-relieving medications which are non-steroidal anti-inflammatory drugs (NSAIDs) would have disastrous consequences, cautions Dr. LakKumar Fernando of the ‘Centre for Clinical Management of Dengue and Dengue Haemorrhagic Fever’ in Negombo.
He is sending out this message to General Practitioners (GPs), some of whom are known as ‘one-shot’ doctors who prescribe NSAIDs to patients for a quick recovery and also the public who either buy these drugs over-the-counter from pharmacies or self-medicate just because someone else with so-called ‘similar symptoms’ has been given these drugs.
With dengue emerging in surges due to the intermittent rains and an epidemic around the corner, this Consultant Paediatrician says that if children have high fever the best is to give them paracetamol and sponge them to bring it down. If the fever lasts more than a day, be it a child or adult, it is best to see a doctor for there is also influenza and COVID-19 doing the rounds.
Referring to the use of NSAIDs, when a person has not been diagnosed with what is ailing him/her, Dr. Fernando says that if it is dengue, NSAIDs would worsen the complications of Dengue Haemorrhagic Fever (DHF) and could also cause death.
NSAIDs which include aspirin, ibuprofen, mefenamic acid and diclofenac sodium, are administered orally in tablet or syrup form or inserted as suppositories.
Fogging being carried out in Dematagoda. Pic by Indika Handuwala
He dispels the myth held by some doctors that prescribing NSAIDs on Day 1 or 2 of fever will not have an impact on the course of dengue illness. If the fever and body aches turn out to be due to dengue, NSAIDs would have two impacts – ‘systemic’ and ‘local’.
The ‘systemic’ effect would be impaired platelet aggregation (clumping together to cause clotting) and an impact on the coagulatory system. The ‘local’ effect would be tiny gastric erosions and if the NSAID has been in suppository form in the rectum, mucosal damage in this region.
The trouble begins when fluid leakage starts as DHF takes its course and the blood pressure drops, says Dr. Fernando, explaining that the patient’s body then attempts a compensatory distribution of blood to the peripheries and vital organs, constricting blood supply at gut level. This results in the gastrointestinal (GI) tract getting affected before the peripheral supply is compromised and the mild gastric erosion caused by the NSAIDs becoming bigger. This is why clinicians see bleeding in the GI tract in the latter part of DHF, stopping of which is not easy.
Sadly, he adds, dengue patients die due to prolonged shock, fluid overload or massive bleeding. The cause of death in a large number is massive bleeding.
| Plea to public: Wipe out mosquito-breeding spotsCheck out and destroy mosquito-breeding spots often and prevent your family being affected by dengue, was the strong appeal that went out from the National Dengue Control Unit (NDCU) of the Health Ministry. With dengue cases hitting over 36,000 just over half a year, compared to over 13,600 for the same period last year (2021), NDCU’s Consultant Community Physician, Dr. Nimalka Pannila Hetti, earnestly requested the public to look into their homes, gardens, schools or adjoining construction sites and wipe out breeding spots even though they are battling many economic issues. (See graphic) “This is the best way to prevent catching dengue,” she stressed, pointing out, however, that if any person has fever for more than 24 hours (one day), he/she should seek medical advice on the second day even though getting about is posing a difficulty.  Dr. Nimalka Pannila Hetti Dr. Pannila Hetti said late presentation can end in serious problems. The dengue virus can cause either Dengue Fever (DF) or Dengue Haemorrhagic Fever (DHF). Those with DF will recover without much of a problem but those with DHF need to take care. At the beginning of this viral fever, there can be no distinguishing between DF and DHF. “This is why we request the public to seek medical help in the second day of fever, for if it is DHF, the person’s condition can deteriorate very fast with fluid leakage which affects the vital organs. Some of the other symptoms include body aches, abdominal pain, vomiting. Please do not wait until you or your loved one is lifeless to seek medical attention,” she urged. Asked whether the fuel scarcity, for both vehicles and machines, was causing a disruption in fogging operations, she said that there are “limitations”. However, fogging is carried out for the adult mosquito and it is more important to clear out breeding spots. “So look in your homes, gardens and schools and also construction sites which can be full of breeding spots and clean them up,” Dr. Pannila Hetti added. | |
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