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

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