Plasma leakage is the most serious complication that distinguishes dengue from severe dengue. In a patient with severe dengue, although plasma leaks from the blood vessels, the red blood cells are too large to pass into the tissue. Severe plasma leakage can result in hypovolemic shock. Excessive IV fluids can lead to respiratory failure. Plasma leakage continues for 24 to 48 hours during which time the patient may have several episodes of shock and look relatively well in-between.

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