COMPLICATIONS OF SEVERE MALARIA

Management of Complications of Severe Malaria

COMPLICATION TREATMENT
Hyperpyrexia
  • Give paracetamol 1 g every 6 hours
    Child: 10 mg/kg + tepid sponging +
    fanning
Convulsions
  • Give diazepam 0.2 mg/kg (max 10
    mg) slow IV or (in adults) IM or 0.5
    mg/kg rectally

If convulsions still persist:

  • Give phenobarbital 200 mg IM/IV
    Child: 10-15 mg/kg loading dose then
    2.5 mg/kg once or twice daily if still
    necessary or
  • Or phenytoin 15 mg/kg loading dose
Hypoglycaemia
  • Adult: dextrose 25% 2 ml/kg by slow
    IV bolus over 3-5 min (to prepare,
    take dextrose 50% 1 ml/kg and dilute
    with an equal volume of water for
    injections)
  • Child: dextrose 10% 5 ml/kg by slow
    IV bolus over 5-7 min (to prepare,
    take 1 ml/kg of dextrose 50% and
    dilute with 4 ml/kg water for
    injection)
  • DO NOT GIVE UNDILUTED 50%
    dextrose
  • Monitor blood glucose frequently
  • Ensure patient is feeding
Acidosis
  • Correct fluid & electrolyte balance
  • If there is severe acidosis without
    sodium depletion:

    • Give sodium bicarbonate 8.4%
      infusion 50 ml IV
    • Monitor plasma pH
Severe anaemia
  • Do blood grouping and crossmatching
  • Transfuse patient with packed cells
    10-15 ml/kg or whole blood 20 ml/
    kg especially if the anaemia is also
    causing heart failure
  • Repeat Hb before discharge and
    preferably 28 days after discharge
Pulmonary
Oedema
  • Regulate the IV infusion (do not
    overload with IV fluids)
  • Prop up the patient
  • Give oxygen
  • Give furosemide 1-2 mg/kg
Acute Renal
Failure
  • Urine output: <17 ml/hour for adult
    or <0.3 ml/kg/hour for a child
  • Check to ensure that the cause of
    oliguria is not dehydration or shock
  • If due to acute renal failure: Give a
    challenge dose of furosemide 40 mg
    IM or slow IV (child: 1 mg/kg)

If this fails:

  • Refer for peritoneal dialysis or
    haemodialysis
Shock
  • If systolic BP <80 mmHg (adult) or
    <50 mmHg (child) or if peripheral pulse absent and capillary refill is slow (>2 seconds)

    • Raise the foot of the bed
    • Give sodium chloride 0.9% by fast
      IV infusion bolus 20 ml/kg in 15 min
    • Review fluid balance and urinary
      outputs
    • Look for evidence of haemorrhage or
      septicaemia and treat accordingly
Haemoglobinuria
(intravascular
haemolysis)
  • Rehydrate the patient
  • Assess for anaemia and transfuse if
    necessary
Dehydration
  • Rehydrate using ORS or IV RL or NS
    (see rehydration)
  • Over-enthusiasitc IV infusion may
    harm the patient and lead to fluid
    overlaod and pulmonary oedema
Bleeding
  • Transfuse patient with whole fresh
    blood to provide lacking clotting
    factors
Coma
  • Check and treat for hypoglycaemia:
    if not responding within 20 min,
    consider another cause
  • Provide intensive nursing care with:
    • IV drip (for rehydration and IV
      medication)
    • NGT (for feeding and oral
      medication)
    • Urethral catheter (to monitor urine
      output)
    • Turning of patient frequently to
      avoid bed sores

Criteria for referral to regional/tertiary hospital

  • Persistent renal failure needing dialysis
  • Any complication that cannot be managed locally