though in soms septic hyperketabolic patients hemodialvsis is preferred 8. Anemia - Blood Exchange transfusi

- immunosuppression 2. High parasitemia (>50000/ml) 3. Severe ARDS 4. Acute renal shutdown or rising serum creatinine 5. DIC3. Persistent lactic acidosis Management 1. Admission to ICU 2. Antimalarial drugs. (a) Quinine sulphate or quininedihydrochloride 20mg/kg in 500 ml N saline infused over 4 hrs, followed by quinine 10 mg/kg infused over 4 hrs every 8 hrs tillpatient is conscious and can swallow. Then oral quinine 600 mg t.d.s. for total treatment of 7 days. Or Quinine 600 mg i.v 8hourly equally effective. In case of G6PD deficiency because af danger of black water fever Mstloquine 20 mg/kg in 2 divideddoses 8-12 hrs apart or Artesunate 480-600 mg oral or i.v. in divided doses for 5 days. (b) Tetracycline 250 mg.q.ds. for 7 daysthrough nasogastric tube. (c) Chloroquine - in chloroquine sensitive areas, i. v. or infusion in a dose of 5 mg/kg in isotonic salineevery 12-24 hrs and substituted by oral medication to total dose of upto 30 mg/kg 3. Fluid and electrolyte balance- Volume of fluidaccording to state of dehydration and urine output. 4. Control of convuisions - Diazepam 0.2 mg/kg repeated every 4 hrs oreariler. If repeated seizures, phenytoin sodium as i.v. bolus at rate of 50 mg/min with monitoring of pulse and B.P. followed byoral/i.v. phenytoin 100 rng q8h 5. Control of cerebral oedema - IV Mannitol infusion. 6. Treatment of hypoglycemia -Hypoglycemia develops due to glucose consumption by the malarial parasite and hyperinsulinemia as a result of quinine therapy.Corrected with i.v dextrose. 7. Oliguria - Acute renal failure should be treated by fluid restriction reduction of maintenance doseof antimalarial by one third, and daily measurements of urea and electrolytes. Uremia can be controlled with peritoneal dialysisthough in soms septic hyperketabolic patients hemodialvsis is preferred 8. Anemia - Blood Exchange transfusion.