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Table 1

From: Falciparum malaria in ICU

Total admissions in the ICU:        96  
Quinine group:    40 patients Non Quinine group:        56 patients
Survived        34          Died      06 Survived        20          Died        36
All Started with Quinine 10 mg/kg Started either with Chloroquine, Sulfadoxine-
(up to max 600 mg thrice a day for 5-10 days) Pyremethamine, Mefloquine with or without
IV Fluids esp. Dextrose Halofantrine, Doxycycline, Norfloxacin
Antibiotics esp. Doxycycline Artemesnin derivatives and others
Other parameters like Mechanical ventilatory support, Blood transfusions, Positive Ionotropes were used indiscriminately for all patients, as the
situation demanded
Complications: Complications:
CNS - Drowsy, altered sensorium responded CNS - Disorientation, Unconsciousness,
well by the 3rd dose of Quinine coma, death
Respiratory- Reversible with prompt treatment Respiratory - Respiratory Failure, ARDS
and others recovered well after mechanical ventilaton  
Renal Failure: High Creatinine due to microvascular Renal Failure - High creatinine, Anuria, ATN
ischemia returned to baseline over a period of time  
DIC, Shock, Multi organ failure were not encountered Hepatic failure, Multi Organ Failure, Hemolysis, Circulatory failure, DIC
Ominous signs of Falciparum  
1) Peripheral smear: due to invasion of young RBCs and sequestration in tissues, a large number of parasites may be invisible on the smear,
thereby giving false assurance of a "low parasite index".
2) Premunition: in holo and hyperendemic areas, due to some degree of acquired immunity, patients are largely asymptomatic early on. It is almost
always late when symptoms manifest overtly.
3) Cerebral Malaria is a "diffuse symmetrical encephalopathy" and therefore sparing mild neck rigidity, signs of meningeal irritation are largely
absent. Mild delerium, obtundation, convulsions etc. are to be taken seriously.
4) Pregnant women are spared gross parasitemia for a long time due to heavy "parasitisation of the placenta".