1

Problem list: Severe falciparum malaria

Subjective data:
CC: 53 .
3
HPI: 4

3
SH: heavy alcohol drinking, heavy smoking > 20

Objective data:
PE: GA: confusion, BW 50, Ht 165
VS: RR 22, BT 38.6
HEENT: mild pale, moderate jaundice
Abd: liver and spleen palpable
Lab: Na 125, BUN 28, Hb 10.8, WBC 8400, PMN 82, Plt 14000, PT
14.3 sec, AST 103, ALT 50,
TB 14.2, Alb 2.0, Urine bilirubin 2+

Thick & Thin film: P. falciparum (ring form, gametocyte)

Assessment:
53 . 3 4

mild pale, moderate jaundice, liver and spleen

palpable lab (Hb 10.8) %Neutrophil (82%
(normal 54-62%)) (14,000) bilirubin
Thick & Thin film P. falciparum (ring form, gametocyte)
infect
Malaria WHO criteria severe malaria

 Total bilirubin 2.5 mg/dL

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Artesunate 2.4 mg/kg

2.4 mg/kg 12 24
artemisinin combination

Plan:
- Artesunate120 mg IV 120mg/kg 12 24

- Artesunate 4 tab PO Day 1-3

- Mefloquine 3 tab(day 1) then 2 tab(day 2)
- Primaquine 2 tab day 3
Goal :
-
-
-

Efficacy monitor: , AST, ALT, TB, UA,
Hb, Plt
Safety monitor:
Artesunate = N/V, Bradycardia, Cerebrellar
toxic
Mefloquine = N/V, CNS S/E, Rash

Primaquine = Hemolytic anemia G6PD def.

Patient education :
-
-
_____________________________________________________________________
_________

2
Problem list : Severe sepsis with non-disseminated melioidosis
Subjective data:
CC:
2
HPI: 2
3
PMH: Alcoholic hepatitis
SH: ,
Objective data:
PE: GA: look ill, BW 50kg
VS: BP100/70, HR 88, RR 22, BT 39.8
HEENT: moderate jaundice
Lung: minimal left pleural effusion
Abd: Liver&spleen palpable
U/S : minimal left pleural effusion
Lab: WBC 13500, PMN 94, Plt 66000, AST 247,ALT 108, TB 15.8
Assessment:
46 .

2 moderate
jaundice, minimal left pleural effusion, Liver&spleen palpable lab

Bilirubin WBC
Melioidosis
Ceftazidime 100mg/kg/d 6 mg/day induction phase

 14 Maintenance phase 20
SMX/TMP (80/400) 2 tab bid Doxycycline
4mg/kg/day (4%)
Plan:
- Ceftazidime 2g IV q.8hr 14
- SMX/TMP (80/400) 2 tab bid20
Goal:

1.

3.

2.

4.

Efficacy monitor: 7-10 ,

AST, ALT, TB, UA, Plt
Safety monitor: SMX/TMP = Rash, Anemia, SJS
Patient education :

 3
1.
Scrub typhus Orientia tsutsugamushi
2.


3.

BUN LFTs
CSF meningitis IFA titer
4.

regimen

- Doxycycline 200 mg PO single dose 100 mg bidx3days

Mild
- Azithromycin 500 mg single dose Doxycycline

- Roxithromycin 10mg/kg/d 7

- Rifampin Doxycycline
5.
Azithromycin 500 mg single dose=
BUN
S/E GI side effect, Hepatitis,
Headache
Reference

.
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World Health Orgarnization.Management of severe malaria

apractical handbook 3rd Geneva. World Health Orgarnization 2012