Treatment

1. Early IV quinine infusion is the mainstay of treatment of severe malaria. Levels should be monitored daily and dosage adjusted as appropriate. Complications include hypoglycaemia and tinnitus. Artemether should be considered in cases of likely quinine resistance.

2. A 2-3l exchange transfusion should be considered if the patient is severely ill or if parasitaemia levels >10-20%.

3. Careful attention must be paid to fluid and electrolyte balance and management of renal failure.

4. Treatment of hypoglycaemia, renal failure, coagulopathy, metabolic acidosis, seizures, ARDS, anaemia and hyperpyrexia follow conventional lines

5. Steroids are not recommended for cerebral oedema.

6. Suspect coincident Gram negative infection with circulatory collapse.

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