›Continuous cardiac monitoring for QTc prolongation
›Blood glucose every 1 to 2 hours
›Cardiology consultation for QRS widening or QTc above 500 ms
›IM artemether
›Loading dose 3.2 mg/kg IM
›Maintenance 1.6 mg/kg IM daily
›Less reliable absorption than IV artesunate
›Acceptable when IV access unavailable
›Pre-referral rectal artesunate
›10 mg/kg suppository for children when parenteral therapy unavailable
›Temporary measure only — proceed to definitive IV treatment urgently
›Glucose management
›Continuous IV dextrose supplementation for high-risk patients
›5 to 10% dextrose maintenance infusion
›Monitoring every 1 to 2 hours mandatory
›Hypoglycemia correction
›Adults: 50 ml of 50% dextrose IV
›Children: 5 ml/kg of 10% dextrose IV
›Fluid management
›Restrictive strategy
›Avoid aggressive fluid boluses
›Pulmonary edema and cerebral edema worsen with excess fluid
›Isotonic crystalloid for documented hypovolemia
›Normal saline or Ringer lactate
›Small boluses 10 ml/kg with reassessment
›Hypotonic fluids contraindicated
›Worsen cerebral edema
›Antipyretics
›Paracetamol for fever management
›Adults: 1 g IV or PO every 6 hours
›Avoid aspirin in thrombocytopenic patients
›Physical cooling measures as adjunct
›Active seizure treatment
›Lorazepam IV first-line
›Adults: 4 mg IV
›Children: 0.1 mg/kg IV
›Diazepam rectal alternative when IV unavailable
›0.5 mg/kg rectally
›Phenytoin or levetiracetam for refractory seizures
›Levetiracetam 20 mg/kg IV over 15 minutes
›Phenobarbitone caution
›Associated with respiratory depression and increased mortality without ventilatory support
›Use only with intubation capability available
Proven harmful adjuncts — do not use
›Contraindicated or ineffective therapies
›Corticosteroids (dexamethasone)
›Increased mortality and prolonged coma in RCTs
›Mannitol
›Increased mortality in children
›No benefit even in raised ICP
›Anti-TNF antibodies
›No benefit shown across multiple RCTs
›Heparin and blood exchange transfusion
›Not recommended per WHO guidelines
Transfusion and complication management
›Red blood cell transfusion
›Threshold in children: hemoglobin below 50 g/l
›Threshold in adults: hemoglobin below 70 g/l with compromised vital signs
›Use leukoreduced packed RBCs
›AKI management
›Strict fluid balance monitoring
›Renal replacement therapy if severe AKI with fluid overload or acidosis
›Drug dose adjustment for reduced renal clearance
›ARDS management
›Lung-protective ventilation
›Tidal volume 6 ml/kg ideal body weight
›Plateau pressure below 30 cmH2O
›PEEP titrated to oxygenation targets