Management of Severe Malaria in Adults In-patients

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TREATMENT

  • If the patient can be weighed, intravenous Quinine is administered in the same manner as for children
  • If the patient cannot be weighed, IV Quinine should be given as follows:
    • First dose 900 mg in one litre of 5% Dextrose or ½-strength Darrow's Fluids given over 3 - 4 hours
    • Subsequent doses 600 mg in one litre 5% Dextrose or ½-strength Darrow's Fluids q12h given over 3 - 4 hours
    • Continue the same IV fluids or Ringer's Lactate (10 ml/kg given over 3 - 4 hours) between doses of Quinine (Give a maximum of about 3 litres per 24 hours to avoid fluid overload)
    • Stop intravenous Quinine as soon as the patient can take food and fluids orally and at least 24 hours of Parenteral Quinine has been administered

Note: What if 60+ kg?

  • Give the appropriate dose of LA beginning 12 hours of the last dose of quinine for 3 days. For pregnant women in the first trimester give oral quinine plus clindamycin for a total of 7 days

COMPLICATION THAT MAY ARISE IN ADULTS

  • Apart from cerebral malaria and anaemia, in adults’ other complications may develop such as:
    • Acute renal failure
    • Respiratory distress syndrome (presenting as severe breathlessness)
    • Disseminated intravascular coagulation (DIC) - presenting as prolonged or spontaneous bleeding
    • Jaundice from severe haemolysis or liver cell damage
  • Management must be appropriate to each complication that develops
  • Fluid and antimalarial drugs are given as for children