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TM: Clinical Malaria (i) (Complications (Metabolic acidosis (widened anion…

- - - - continuous
      - remittent
        
        remains above normal throughout day
        
        over 1 degree variation per 24 hrs
      - Tmax NB as quantitative measure of fever
        
        max temp in a 24 hr period
        
        quantifies response to tx
      - low grade fevers often not clinically relevant
- - - - deteriorating consciousness/coma
      - generalised convulsions
      - extensor posturing
        
        scores a 2 on GCS (flexor scores 3)
        
        aka decerebrate posturing
        
        head/neck arched back
        
        arms adducted + extended by sides
        
        lungs extended
      - shock - give dextrose to save brain
  - - - also due to sequestration + destruction of platelets
  - - - decreased gas exchange due to lung insults
      - trauma, surgery, infection
      - type 1 hypoxic resp failure
      - lung whiteout on CXR (ddx = pneumonia/cancer)
      - transfer to ICU
      - challenging to oxygenate
  - - - divergent gaze
        
        brainstem pathology
        
        cranial N III/IV/VI disorder
        
        ocular palsy
        
        if acute onset it's not a strabismus
    - - mimics meningitis
      - nuchal rigidity
      - decorticate rigidity (abnormal flexion)
      - decerebrate regality (abnormal extension)
  - - - lysis of parasitised RBCs
      - immune-mediated lysis of non-parasitised RBCs
      - sequestration of parasitised RBCs
      - sequestration of Fe
      - dyserythrogenesis (defective RBC development)
      - erythrophagocytosis (erythrophages = monocytes + neutrophils)
  - - - K+ shift extracellularly
      - too many H+ ions in blood