Management of Complicated Malaria

Management of complicated malaria

To reduce the unacceptably high mortality of severe malaria, patients require intensive care. Clinical observations should be made as frequently as possible.

General supportive measures include airway maintenance, nursing the patient on their side, fanning if hyperpyrexia is present, and close monitoring of fluid balance.

Management of Coma (Cerebral malaria)

• Maintain airway

• Nurse the patient on their side

• Exclude other causes of coma (e.g. hypoglycaemia, bacterial meningitis)

• Avoid corticosteroids

Management of dehydration

• Correct dehydration appropriately and monitor fluid balance carefully

Management of hyperpyrexia

• Use fanning to reduce temperature

• Paracetamol may be given if the patient can swallow

Management of convulsions

• Maintain airway

Adults

• Diazepam (IV) 0.15 mg/kg (maximum 10 mg) slow IV bolus

Children

• Diazepam (rectal) 0.5–1.0 mg/kg

• If convulsions persist after 10 minutes, repeat rectal diazepam

• If seizures continue despite a second dose, give a further dose of rectal diazepam OR Phenobarbitone (IM/IV) 20 mg/kg after another 10 minutes

Note (Rectal diazepam administration)

Draw the IV preparation into a small syringe and remove the needle. Insert approximately 5 cm of a nasogastric tube into the rectum. Inject the diazepam into the nasogastric tube and flush it with 5 ml of water. If a nasogastric tube is not available, a syringe without a needle may be used. Hold the buttocks together for a few minutes to ensure retention and absorption of the medicine.

Management of Hypoglycaemia

Hypoglycaemia is a major problem in severe malaria, especially in young children and pregnant women. It should be actively sought and treated with repeated blood glucose monitoring.

Children

• Dextrose 10% (IV) 5 ml/kg OR Dextrose 25% (IV) 2.5 ml/kg as bolus

If 50% dextrose is available, dilute it to 25% by adding an equal volume of water for injection or normal saline.

Adults

• Dextrose 10% (IV) 125 ml OR Dextrose 25% (IV) 50 ml as bolus

If dextrose is not available, sugar water may be prepared by mixing 20 g of sugar (4 level teaspoons) with 200 ml of clean water. Give 50 ml orally or via nasogastric tube if the patient is unconscious.

Management of Severe anaemia

• Refer to haematology management guidelines

Management of Acute pulmonary Oedema

• Refer to respiratory disease management guidelines

Management of Acute renal failure

• Refer to cardiovascular disease / renal management guidelines

Management of Shock

• Refer to emergency and critical care management guidelines