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How to Treat Malaria Severe?

  • July 26, 2023
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How to Treat Malaria Severe?

Things to note:
  • Maintain hydration but avoid Excessive fluid administration because this could contribute to ARDS( especially during pregnancy).
  • Transfuse less than 6 g/dL, if haemoglobin.
  • There is no convincing evidence that the exchange transfusion is beneficial.
Medical Treatment:
Quinine, IV( 1 mL= 300 mg of salt of quinine).
  • Loading dose: 20 mg / kg 5 percent administered over 4 hours in dextrose.
  • Maintenance dose: give 10 mg / kg in dextrose 8 hours after starting the loading dose 5 percent over 4 hours repeated every 8 hours until clinical improvement occurs and the patient can take oral therapy.
  • Hypoglycemia and dysrhythmias monitor.
  • If the dose interval increases to 12 hours after 48 hours if renal failure is significant.
To ensure adequate absorption, follow:
* Artemether / lumefantrine 20/120 mg, oral, 4 tablets / dose with food containing fat or full cream milk.
  • Immediately give the first dose.
  • 8 hours later, give the second dose.
  • Then for another 2 days, 12 hours. Total 3-day number of doses= 6).
Check treatment with regular blood smears. Due to the release of sequestrated parasites, an increase in parasitemia may occur within 24 hours, but a reduction should be seen after 48 hours.
Gametocytes may occur after this stage, which does NOT mean therapy failure. Only the reappearance of trophozoites or failure to clear them means failure.
When to refer:
  • Patients requiring ventilation or dialysis if not available on site.

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