CASE PRESENTATION

ON CEREBRAL MALARIA
Age :17yrs Ipno:74801
Sex :M Unit :I
DOA:12-08-08
Reason for admission

C/o fever (high grade)with chills and

rigors
vomiting since 8 days
h/o headache
PMHx :NS
Allergies :NKA
Day :1 BP:120/80
o/e febrile(104 F) Pulse:89
Tachycardia +
Hepatosplenomegaly +

…Adv:Hb,TLC,DC,ESR,PLT,PBS,
RBS,U/C,S/E,CHEST XRAY,QBC
MP,WIDAL,URINE ROUTINE
Rx:
Paracetamol 650 mg 1-1-1
Inj.Quinine dihydrochloride 450 mg1-1-1
Inj.Ondansetron 4mg 1-1-1
Inj.Diclofenac 1 amp stat
IVF DNS
T.Pyrimethamine(25mg)+
sulfadoxime(500mg) stat
Platelet concentrate 2units
Inj.Dexamethasone 8 mg stat 1-1-1
Provisional Diagnosis:

Cerebral Malaria
Day2:
O/e afebrile, hepatomegaly+ BP: 126/86 mm Hg
PR: 86Bpm
Hb: 12 g%
WBC: 12100 cells/ mm3
N: 81% Biochemistry
L: 16% RBS:103mg/dl
M: 01% Urea:18mg/dl
B: 00% Se.Cr: 0.9mg/dl
E: 02%
SERUM ELECTROLYTES
PLT: 18000 cells/mm3 Na:127mmol/l
K:4.5mmol/l
ESR:35 mm/Hr Cl:99mmol/l
Day 2 con………
WIDAL -ve

QBC MP:P.Vivax + P.Falciparum +

Ring forms of plasmodium falciparum

&
Ring forms and schizonts of plasmodium vivax
are seen
Day 2 con..

Rx:
Pyrimethamine+sulfadoxime stopped
Inj.Quininedihydrochloride 1-0-0
Inj.Ondansetron sos

Adv….
repeat QBC MP,CST
 Day3: BP: 130/70 mm Hg
PR: 80Bpm
O/E GC fair
 No fresh complaints
 Afebrile

 Adv…repeat platelet count

 Rx:
 T.Paracetamol sos
 Inj.Quininedihydrochloride stopped
 Inj.Dexamethasone1-0-1
 CST
DAY 4
B.P: 120/70 mmHg
Pulse: 82bpm

 Gc stable
 Patientfeels better
 Adv….QBC MP
Rx
Inj.Dexamethasone 1-0-0
T.Doxycycline 100 mg 1-0-1
 Day:5 Bp:120/80mmHg
Pulse:80bpm
O/e afebrile,
Hepatosplenomegaly+
QBC MP negative
Platelet:88000cells/mm
Rx:
Inj Dexamethasone stopped
T.Primaquine 15 mg stat (3 tab)
CST
 Pharmaceutical Care Plan
 Subjective evidences  Objective evidences
 Fever  QBC MP-revealed ring
 Associated with chills& forms of p.falciparum
rigors and ringforms &
 Headache
schizonts of p.vivax
 Vomiting
DIAGNOSIS:

MALARIA: P.Falciparum &P.Vivax

Goals Of Treatment:

To cure the disease

To prevent relapse
To prevent complication
Tretment options:
Chloroquine

Primaquine Quinine
Artesunate Artemether
Malarone Tetracycline
Mefloquine
Monitoring Parameters

QBC MP
CBC
ADR
Goals achieved:

Signs and symptoms relieved

(fever,vomiting,headache
relieved)
QBC MP negative
Problems identified:

NIL
Patient counselling
 About disease:
 vector
 Signs and symptoms
 complication

 About medication:
 Medication adherance
 Dose and frequency
 ADR
Patient Counselling…

About life style Modification:

Use mosquito nets &repellant
Iron rich diet