Management of Complications of Falciparum Malaria
| Complication | Management |
|---|---|
| Hypotension | Transfer to high dependency unit. Give IV fluids to maintain blood pressure but caution against fluid overload. Maintain adequate oxygenation. Start inotropic vasopressor therapy if systolic BP remains <90 mmHg despite fluids (Chapter 2). Start antibiotic therapy for possible coexistent Gram-negative sepsis after taking blood cultures (Chapter 35). |
| Hypoglycaemia | This is a common complication. Blood glucose should be checked 4-hourly, or 2-hourly while on IV quinine, or whenever conscious level deteriorates or if seizures occur. If blood glucose is <4 mmol/L, give 100 mL of glucose 20% IV and start an IV infusion of glucose 10% (initially 1L 12-hourly) via a large peripheral or central vein. |
| Seizures | Recheck blood glucose. Manage along standard lines (Chapter 16). Exclude coexistent bacterial meningitis by CSF examination (NB lumbar puncture should not be done within 1h of a major seizure). |
| Pulmonary oedema | May occur from excessive IV fluid or ARDS (Chapter 47). Manage along standard lines (Chapter 47). |
| Renal failure and acidosis | Haemofiltration may be needed for renal failure or control of acidosis or fluid/electrolyte imbalance. |
| Anaemia and thrombocytopenia | Both improve after several days of malaria chemotherapy. Anaemia is haemolytic and transfusion is only required for severe symptomatic anaemia. Thrombocytopenia is common and may be profound but platelet transfusions are not usually indicated. |
ARDS, acute respiratory distress syndrome; CSF, cerebrospinal fluid.