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Table 1 Availability of means to assess diagnostic and prognostic parameters, and provide treatment of severe malaria at Battambang Referral Hospital

From: Severe malaria in Battambang Referral Hospital, an area of multidrug resistance in Western-Cambodia: a retrospective analysis of cases from 2006–2009

WHO severe malaria criteria Description as published in national guidelines Availability at BRH Treatment available
Prostration Inability to sit upright without support or to drink Yes Supportive only
Impaired consciousness Modified Glasgow score ≤ 9 in adult and children >5 years old or Blantyre coma score ≤ 2/5 in children who have not learned to speak Yes Supportive only
Respiratory distress Sustained nasal flaring, intercostals recession and deep or fast breathing (RR >25/min in adults and >40/min in children) Yes Limited - no ventilators, low flow oxygen only
Multiple convulsions > 1/24 h Yes Parenteral or NG diazepam
Circulatory collapse BP <50 mmHg before 5 years old or BP <80 mmHg above 5 years old, cool peripheries, weak pulses Yes Peripherally administered IV pressors, fluids
Pulmonary oedema Radiological features Yes Limited - diuretics, oxygen, morphine
Abnormal bleeding (No definition provided) Yes Blood transfusion (limited)
Jaundice (No definition provided) Yes Supportive
Haemoglobinuria (No definition provided) Yes Blood transfusion (limited)
Frequent vomiting Vomiting everything with inability to retain food or medicines Yes Antiemetic drugs, parenteral route of drug administration
Laboratory finding
Severe anaemia (or pallor) Hb <5g/dl or Ht <15% Yes Blood transfusion (limited)
Hypoglycaemia Glycaemia <2.2 mmol/l or 0.4 g/l Yes IV dextrose
Metabolic acidosis Plasma bicarbonate <15 mmol/l No IV fluids
Hyperlactataemia Plasma lactate >5 mmol/l No IV fluids
Hyperparasitaemia P. falciparum “++++” or >200 000 parasites/μ l Often Intramuscular artemether
Renal failure (or oliguria) Urine output <400 ml/24 h or plasma creatinine>265 μ mol/l in adult or urine output <12 ml/kg/24 h or plasma creatinine above the age-related normal range, persisting after rehydration in children Clinical only - rare lab tests Peritoneal dialysis occasionally available; supportive care