Management of Severe Malaria
（1）Critical Care Pathways（CCPs）
①Level of consciousness（using coma score，see annex）.
②Vital signs every 4 hours（temperature，pulse，respiration，blood pressure）.
③Fluid balance（urine volumes，chest sounds）.
④Increasing anaemia（pallor，heart failure with increasing liver size）.
⑤Occurrence of convulsions-see item 2 in previous Box.
⑥Blood glucose every 4 hours while unconscious and also if convulsions occur.
⑦[Hb]/Packed Cell Volume-at least daily，or more often if anaemia is suspected.
⑧Educate the patient and relatives about home prevention of malaria.
（2）Severe Malaria Treatment with Intravenous Quinine in Children
①Initial（loading）dose 20 mg（quinine salt）/kg body weight：inject this dose into 10 mL/kg 5%dextrose infuse over 3～4 hours.(https://www.daowen.com)
②If patient has already received quinine for this illness，the first dose IV infusion should be 10mg/kg given over 3～4 hours with no loading dose.
③Subsequent doses of 10 mg/kg every 12 hours should be given in the same way continue the same IV fluid（10 mL/kg given over 3～4 hours）between doses of quinine.
（3）Severe Malaria Treatment in Adults
①Malawians returning from long stay（at least 1 year）in a Nonmalarious country.
②Expatriates from non-malarious countries.
③Pregnant women.
④Splenectomised individuals.
⑤Patients with HIV/AIDS.
⑥The management of adults with severe malaria must be appropriate to each complication that develops.Fluid and antimalarial drugs are given as for children.If the patient cannot be weighed，IV Quinine should be given as follows：First dose 900 mg in 1 litre of fluids given over 3～4 hours.Subsequent doses 600 mg every 12 hours given over 3～4 hours.
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