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Overview :
A poor prognosis for severe malaria in children can often be
indicated by clinical and laboratory findings.
Differences between children and adults with severe malaria:
(1) Common
causes of death in adults are acute renal failure and acute pulmonary edema, but
these are rare in children.
(2) Common
causes of death in children are severe anemia and lactic acidosis.
|
Indicator |
Findings
indicating a poor prognosis |
|
neurological status |
combination of cerebral malaria with coma and extensor
posturing |
|
hypoglycemia |
blood glucose < 2.2 mmol/L |
|
heart rate (tachycardia) |
> 150 beats/minute |
|
respiratory rate (tachypnea) |
> 50 breaths per minute |
|
hyperlactatemia |
plasma lactate > 5 mmol/L |
|
malarial parasites in peripheral blood |
parasite count > 500,000 per µL |
|
malarial parasites in peripheral blood |
> 40% trophozoites (pigment evident in asexual
stage) |
where:
• Coma is indicated by a Blantyre coma score of 0, 1 or 2.
|
Additional
Laboratory Indicators |
Findings
indicating poor prognosis |
|
serum urea nitrogen |
> 6.4 mmol/L |
|
"corrected" serum calcium |
> 2.2 mmol/L |
|
serum potassium |
> 5 mmol/L |
|
serum albumin |
normal |
|
liver function tests |
elevations of
total bilirubin, GGT, AST |
where:
• Serum albumin in survivors is usually mildly decreased.
• How the
serum calcium is "corrected" is not stated, but is assumed to be for low serum
albumin [approximate total serum calcium in mg/dL with normal albumin = (current
total serum calcium in mg/dL) + (0.8 * (4 - (albumin in g/dL)); approximate
total serum calcium in mmol/L with normal albumin = (current total serum calcium
in mmol/L) + (0.8 * (1 - ((albumin in g/L) /40))].
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