SINGAPORE - In spite of their best efforts, doctors could not beat the dengue virus which overwhelmed Mr Ang Yong Han, 20, the first person to die of the mosquito-borne disease this year, said a senior doctor at the hospital which treated him.
Not only were his blood vessels leaking fluid, making his blood very concentrated and causing his blood pressure to plummet, the virus had also caused inflammation in his liver and brain, said Associate Professor Lim Poh Lian, head of infectious diseases at the Tan Tock Seng Hospital (TTSH).
Mr Ang died at 7.34 am on Wednesday, exactly a week after he first fell ill.
He had gone to the emergency department at TTSH three times, according to the hospital and his mother, Madam Yap Geok Kuan.
On his first visit on May 23, he was in stable condition and dengue was suspected. He was given Panadol and told to see a doctor in three days' time, or to return if his condition worsened.
This happened two days later and he returned to the hospital, which said he arrived at 3am and was seen by a nurse within five minutes.
But he did not get to see a doctor after waiting for more than two hours. He approached a nurse at 5.18am to cancel his registration, and left.
Mr Ang was back at the hospital in the early hours of Sunday with fever, body aches and vomiting. He was given fluid intravenously and admitted to the Communicable Diseases Centre (CDC).
He was seen by the medical officer (MO), who tested his blood twice that day. It showed that his liver was inflamed.
In normal people, levels of the enzyme Aspartate transaminase (AST) are between 10 and 40 units per litre of serum. In dengue patients, 200 to 500 is common, said Prof Lim. But in Mr Ang's case, the level "was way off the charts" at 1,000, and it later rose to more than 4,000.
Early on Monday morning, the MO called the registrar (or trainee specialist) on duty because Mr Ang appeared confused and complained of stomach pain.
He also had a high concentration of red blood cells - an indication that fluid was leaking out of his blood vessels. He was moved to a high dependency unit.
With no cure for dengue, patients are treated for pain and kept hydrated as far as possible.
Mr Ang received more than 30 litres of fluids and blood products while he was in hospital, including transfusions of blood, plasma and platelets.
Later on Monday, however, he took a turn for the worse.
When his confusion persisted on Tuesday, a scan of his brain was taken. It showed some inflammation, according to Prof Lim.
Mr Ang's blood pressure started to fall and continued to do so even after he was given strong medication.
His heart eventually stopped, she said. He could not be resuscitated.
Mr Ang's family have asked whether he could have been saved if he had been admitted to hospital earlier.
Madam Yap said she had set off with her son for the hospital on Saturday morning but they turned back home in the cab at his request.
Prof Lim said his condition deteriorated on Monday, and it would not have made any difference if he had been admitted to the hospital a day or two earlier.
When to see a doctor
When to see a doctor
More than 640 people were infected by dengue in the week ended last Saturday, and 568 more by 3pm yesterday. This brings the total for the year to 8,305.
Experts, who expect numbers to continue to climb, have this advice to the public.
If you have a fever, a headache, muscle or eye ache, you should see a doctor.
Do not take aspirin or non-steroidal anti-inflammatory drugs, commonly known as Nsaids, such as Ibuprofen or Synflex. If you have dengue, it could make your condition worse.
Panadol, however, is safe, says Associate Professor Lim Poh Lian, head of infectious diseases at the Tan Tock Seng Hospital.
If you remain sick after a couple of days, you should return to the same doctor, who can then reassess your condition.
Most people who have dengue do not need to be hospitalised. But they must drink a lot of fluids, preferably isotonic drinks, as they would lose a lot of electrolytes. This is especially when they are vomiting or having diarrhoea.
Get a copy of The Straits Times or go to straitstimes.com for more stories.