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aria
– Slow , d eep breath ing (acid osis):
L ook for d eh yd ration (and correct if present), d ecom pensated anaem ia (and transfuse
if present).
Oliguria and acute renal failure
L ook first for d eh yd ration ( pag e 3 1 5 ) , especially d ue to inad equate fluid intake or
excessiv e fluid losses (h ig h fev er, v om iting , d iarrh oea) . T reat d eh yd ration, if present
(pag es 3 1 6 to 3 2 1 ). B e aw are of th e risk of fluid ov erload and acute pulm onary oed em a.
M onitor for th e return of urine output.
A cute renal failure (A R F ) is found alm ost exclusiv ely in ad ults and is m ore com m on in
A sia th an A frica. A R F sh ould be suspected if urine output rem ains < 4 0 0 m l/ d ay or
< 2 0 m l/ h our ( < 1 2 m l/ kg / d ay in ch ild ren) d espite ad equate reh yd ration. I nsert a
urinary cath eter, m easure output. R estrict fluid s to 1 litre/ d ay ( 3 0 m l/ kg / d ay in
ch ild ren), plus ad d itional v olum e equal to urine output. R enal d ialysis is often necessary.
Antimalarial treatment in pregnant women
– Uncomplicated falciparum malaria
• D uring th e first trim ester, quinine P O for 7 d ays (± clind am ycin) is in principle
preferred as it is better know n. H ow ev er, A C T m ay be used if necessary (except
D H A / P P Q ), e.g . if quinine is not av ailable, or if th e treatm ent failed or if ad h erence
to quinine treatm ent is uncertain.
• D uring th e 2nd andrd3 trim esters, th e treatm ent of ch oice is an A C T ( except
D H A / P P Q ); quinine is an alternativ e.
– Severe malaria
• D uring th e first trim ester, artem isinin d eriv ativ es or quinine m ay be used .
• D uring th e 2nd andrd3 trim esters, th e treatm ent of ch oice is an artem inisine
d eriv ativ e; quinine is an alternativ e.
Prevention 9
– I n areas w ith h ig h risk of infection w ith P. falciparum, preg nant w om en sh ould be
tested for m alaria at reg ular interv al d uring antenatal clinic v isits. A ll w om en w ith a
positiv e test sh ould receiv e a 3 d ay-course of A C T . W om en w ith neg ativ e(s) test(s)
sh ould receiv e SP (as a sing le d ose) for its prev entiv e effect, accord ing to a specific
sch ed ule (refer to th e M SF h and book, Obstetrics), but only in reg ions w h ere SP still
h as sufficient efficacy.
– I n m alaria end em ic zones and in epid em ic- prone contexts, all in- patient facilities
( includ ing H I V treatm ent centres and feed ing centres), sh ould be furnish ed w ith
long -lasting insecticid al nets (L L I N s).
9 See specialised literature for information regarding anti-vector measures and prevention in travellers.
138
– Slow , d eep breath ing (acid osis):
L ook for d eh yd ration (and correct if present), d ecom pensated anaem ia (and transfuse
if present).
Oliguria and acute renal failure
L ook first for d eh yd ration ( pag e 3 1 5 ) , especially d ue to inad equate fluid intake or
excessiv e fluid losses (h ig h fev er, v om iting , d iarrh oea) . T reat d eh yd ration, if present
(pag es 3 1 6 to 3 2 1 ). B e aw are of th e risk of fluid ov erload and acute pulm onary oed em a.
M onitor for th e return of urine output.
A cute renal failure (A R F ) is found alm ost exclusiv ely in ad ults and is m ore com m on in
A sia th an A frica. A R F sh ould be suspected if urine output rem ains < 4 0 0 m l/ d ay or
< 2 0 m l/ h our ( < 1 2 m l/ kg / d ay in ch ild ren) d espite ad equate reh yd ration. I nsert a
urinary cath eter, m easure output. R estrict fluid s to 1 litre/ d ay ( 3 0 m l/ kg / d ay in
ch ild ren), plus ad d itional v olum e equal to urine output. R enal d ialysis is often necessary.
Antimalarial treatment in pregnant women
– Uncomplicated falciparum malaria
• D uring th e first trim ester, quinine P O for 7 d ays (± clind am ycin) is in principle
preferred as it is better know n. H ow ev er, A C T m ay be used if necessary (except
D H A / P P Q ), e.g . if quinine is not av ailable, or if th e treatm ent failed or if ad h erence
to quinine treatm ent is uncertain.
• D uring th e 2nd andrd3 trim esters, th e treatm ent of ch oice is an A C T ( except
D H A / P P Q ); quinine is an alternativ e.
– Severe malaria
• D uring th e first trim ester, artem isinin d eriv ativ es or quinine m ay be used .
• D uring th e 2nd andrd3 trim esters, th e treatm ent of ch oice is an artem inisine
d eriv ativ e; quinine is an alternativ e.
Prevention 9
– I n areas w ith h ig h risk of infection w ith P. falciparum, preg nant w om en sh ould be
tested for m alaria at reg ular interv al d uring antenatal clinic v isits. A ll w om en w ith a
positiv e test sh ould receiv e a 3 d ay-course of A C T . W om en w ith neg ativ e(s) test(s)
sh ould receiv e SP (as a sing le d ose) for its prev entiv e effect, accord ing to a specific
sch ed ule (refer to th e M SF h and book, Obstetrics), but only in reg ions w h ere SP still
h as sufficient efficacy.
– I n m alaria end em ic zones and in epid em ic- prone contexts, all in- patient facilities
( includ ing H I V treatm ent centres and feed ing centres), sh ould be furnish ed w ith
long -lasting insecticid al nets (L L I N s).
9 See specialised literature for information regarding anti-vector measures and prevention in travellers.
138
