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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.
Note:
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.