›Aggressive IV rehydration for dehydration and electrolyte loss
›Isotonic crystalloid preferred
›Potassium correction
›Hyperkalemia management: calcium gluconate, insulin/dextrose, sodium bicarbonate
›Metabolic acidosis correction
›Sodium bicarbonate if pH < 7.1 or bicarbonate < 10 mmol/l
›Antipyretics and symptom management
›Paracetamol (acetaminophen) for fever
›Avoid NSAIDs (platelet inhibition in hemorrhagic context)
›Antiemetics for nausea and vomiting
›Ondansetron 4 to 8 mg IV every 6 to 8 hours
›Analgesics for pain
›Opioids if severe pain; with caution for respiratory depression
›Seizure management
›Benzodiazepines first-line
›Lorazepam 0.05 to 0.1 mg/kg IV (maximum 4 mg per dose)
›Diazepam 5 to 10 mg IV if lorazepam unavailable
›Levetiracetam for recurrent seizures
›20 to 30 mg/kg IV loading dose
Hemorrhage and blood product management
›Blood transfusion indications
›Hemoglobin < 70 g/l (or < 80 g/l if hemodynamically unstable)
›Active significant hemorrhage
›Fresh frozen plasma for coagulopathy
›PT/INR > 1.5 with active bleeding
›Platelet transfusion
›Platelets < 50 x 10^9/l with active bleeding
›Avoid
›Nephrotoxic agents (aminoglycosides, gentamicin)
›NSAIDs and aspirin
›Intramuscular injections (hemorrhage risk)
›Supplemental oxygen escalation
›Nasal cannula to face mask to high-flow nasal cannula
›Target SpO2 92 to 96%
›Non-invasive ventilation with caution
›Aerosol generation risk; full PPE mandatory
›Mechanical ventilation for respiratory failure
›Low tidal volume strategy 6 ml/kg ideal body weight
›PEEP titration for ARDS
Renal replacement therapy
›Indications
›Refractory hyperkalemia (> 6.5 mmol/l)
›Severe metabolic acidosis (pH < 7.1)
›Fluid overload unresponsive to diuretics
›Oliguria with rising creatinine
›Recovery of renal function is crucial for survival
›Creatinine normalization associated with 0% case fatality
›Persistent renal failure associated with 62% case fatality
Concurrent infection treatment
›Malaria co-treatment
›Treat if smear or RDT positive
›Artemether-lumefantrine per local protocol
›Bacterial superinfection
›Empiric antibiotics if secondary bacterial pneumonia or sepsis suspected
›Avoid aminoglycosides
›Dexamethasone (adjunctive)
›Case reports of use for concomitant hyperinflammation
›Not routine; consider in consultation with infectious disease
Post-exposure prophylaxis
›Oral ribavirin for high-risk contacts
›Per CDC guidelines
›35 mg/kg/day in 3 divided doses for 10 days
›Maximum 2.5 g/day
›High-risk contacts isolated until 2 days of prophylaxis completed
›21-day monitoring period from last exposure