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2management SM & COMPL-19
2management SM & COMPL-19
Severe Malaria
and complications
Paul.N. Harijanto
MANAGEMENT SEVERE MALARIA
SUSPECTED CASE
SPECIFIC TREATMENT
ANTI MALARIAL DRUGS
Early identification & Diagnosis
Failed to take a proper history ( travel history,
location of living )
Availablity microscopic examinations/ RDT
Convulsion
Hemodinamiccally unstable
Sepsis
Vomiting everything
Multiple convulsions
Lethargy
Unconsciousness
Stiff neck
QUININE
QUINIDINE
RECOMMENDED DOSES OF ANTI MALARIAL DRUGS FOR
TREATMENT OF SEVERE MALARIA
ARTEMETHER I.M
1 Amp = 80mg
1 Fl = 60 mg
Pre-Treatment 12 hours after Artesunate
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SETELAH KESADARAN MEMBAIK/DAPAT MINUM :
20 mg/kgBB IV infus/100-500 ml/4 jam GANTI PER-ORAL 10 MG/KGBB/8 JAM
Berat badan …. Kg SAMPAI HARI KE-7
10 mg/kgBB
IV infus 200 ml/4 jam 10 mg/kgBB
Infus kosong 4 jam IV infus 200 ml/4 jam
diulang tiap 8 jam
(tanpa kina)
0 4 8 12 16 20 24
19/07/2019 Dr Hardianto Setiawan
WAKTU (JAM)
TREATMENT OF PARENTERAL QUININE- HCL
500 mg Kina HCl (1 amp) 500 mg Kina HCl (1 amp) 500 mg Kina HCl (1 amp)
dalam 500 cc Dextrose 5% dalam 500 cc Dextrose 5% dalam 500 cc Dextrose 5%
0 4 12 16 20 24
19/07/2019 Dr Hardianto Setiawan
WAKTU (JAM)
Piggy
Dextrose 5% Cairan Back
Maintenance
Kina
Microdrips
100-200 cc
CARA PEMBERIAN
KINA PADA
MALARIA BERAT
Penyesuaian dosis pada gangguan Fungsi Organ
Kina i.m.
Treat hyperpyrexia
GENERAL SUPPORTIVE MEASURES
Urinary catheterization should be used to monitor output
Manajemen :
Klinis dehidrasi : lakukan re-hidrasi Na Cl 0.9%,
10 ml/kg/jam ( 500ml/jam untuk 50 Kg)
Mencegah kelebihan cairan : respirasi rate,
askultasi paru, JVP, Oksimetri nadi,
CVP mesti di evaluasi setiap 200 ml cairan.
CVP : 0 – 5 cm
Diuretic in oliguric AKI
MANAGEMENT & DETECTION VITAL ORGAN FAILURE :
Children :
Compensated : Clin impaired perfussion (2 or > of CRT >3s,
weak pulses, severe tachycardia & cool peripheries +
normal BP
Decompensated : 1 or > above + sys <70 mmHg
Norepinephrine ( nor-adrenaline) :
dopamine/ epinephrine, 250 mg/ 500ml NS,
dose tailoring.
Choice AB :
Broad-spectrum : Ceph. III/IV, Carbapenem
Considering local AB guideline (Empheric Rx) or
culture results
J. Penanganan terhadap infeksi sekunder/
sepsis
WHO (2015), merekomendasikan pemberian antibiotik broad-spektrum
pada malaria berat pada anak sampai dipastikan tidak ada infeksi
bakterial.
Mobilisation
Spesific supportive treatments
Inserted Guedel oropharyngeal airway prevent
aspiration
Oral hygiene
Telp.: +62-431-351046(Bethesda)
+62-812-431-2869 (HP)
E-mail : paulharijanto@gmail.com