MalariaEmergency

Fever with rigors for 5 days, now drowsy and jaundiced; creatinine 3.4, Hb 68 g/L, glucose 52 mg/dL; P. falciparum 8% parasitaemia (P. vivax can also be severe in India)

• Impaired consciousness or seizures
• Glucose <40 mg/dL
• SpO₂ falling / crackles
• Oliguria
• Parasitaemia >10%

• Dengue
• Leptospirosis
• Scrub typhus
• Typhoid
• Bacterial sepsis / meningitis
• Viral hepatitis

• Admit: Any severity feature, falciparum with vomiting, pregnancy, children, high parasitaemia
• ICU: Cerebral malaria, ARDS, shock, AKI needing dialysis, acidosis
• Intubate: GCS ≤8, airway compromise, respiratory failure
• Dialysis: Early for oliguric AKI, acidosis, overload

• IV artesunate reduces severe malaria mortality by about a third compared with quinine.
• Hypoglycaemia is common (disease, quinine, pregnancy) — check glucose every few hours.
• Treatment is free under NCVBDC; notify every case.

• Delay artesunate for any reason
• Give liberal fluid boluses (pulmonary oedema)
• Give steroids, mannitol or heparin for cerebral malaria
• Exclude malaria on one negative smear in a febrile patient from an endemic area
• Give primaquine without G6PD testing

• Single negative film
• Delayed artesunate
• Over-hydration
• Missing hypoglycaemia
• No G6PD before primaquine

ICU/HDU for severe malaria; ward once improving. Hb review up to day 28.