| Non-drug Therapy | |
- Maintain normal blood glucose levels in patients with severe malaria.
- Consider exchange transfusion in some cases as an adjunct in the treatment of severe P. falciparum malaria.
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Maintain normal blood glucose levels in patients with severe malaria.  |
- Check serum glucose at presentation and every 4 hours during the course of the disease, as well as with seizures or any acute change in mental status.
- Administer 5% or 10% dextrose infusions as needed to keep serum glucose in the normal range.
| Background | Back to top
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Consider exchange transfusion in some cases as an adjunct in the treatment of severe P. falciparum malaria. |
- Consider exchange transfusion in patients who meet World Health Organization guidelines for severe malaria:
- Parasitemia >30% in the absence of clinical complications
- Parasitemia >10% in the presence of severe disease, especially:
- Cerebral malaria
- Acute renal failure
- Adult respiratory distress syndrome
- Jaundice
- Severe anemia
- Parasitemia >10% and failure to respond to optimal chemotherapy after 12 to 24 hours
- Parasitemia >10% and poor prognostic factors, such as:
- Elderly patient
- Late-stage parasites in peripheral blood
- Be aware that exchange transfusion:
- May be harmful and is associated with fluid overload, risk of transfusion reactions and related infections, and line sepsis
- Does not remove infected erythrocytes that are sequestered in deep tissue capillary beds, including those in the brain
- Does not reduce the parasitemia to zero
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Harry Tagbor, MBChB, DrPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Rick M. Fairhurst, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Thomas E. Wellems, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given. |
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Malaria
