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File: 123096_sep96_decls23_0025.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
Complications: the following complications strongly indi- G. "Blackwater Fever:-'
cate infection with P. el arum: 1. Massive hemolysis and hemoglobinuria in the
setting of P. falciparum malaria is traditionally
A. Hyperparasitemia: > 5% of RBC's on smear parasitized; called blac7kwater fever.
correlates with other complications, though complica- 2. Incidence has decreased with use of modern
tions can be seen with lower degrees of parasitemia. antimalarials. Its occurrence has been associated
with quinine use, oxidant antimalarials in G6PD-
B. Cerebral malaria: deficient patients, or possibly as the result of
1. Altered mental status,.personality changes, an atypical immune response. Other causes of
lethargy, stupor, coma or delirium. massive hemolysis must be excluded.
2. Neurologic impairment: hyperpyrexia, monoplegia, 3. Treatment includes appropriate antimalarials,
hemiplegia, cerebellar signs, seizures (assess for transfusions and the prevention or management of
hypoglycemia). acute renal failure, including dialysis in some
3. Treatment is directed at overall infection, cases.
of value.
4. Mortality is high (20-50%) but survivors rarely VI. Treatment:
show neurologic sequelae. A. Treatment of choice:
C. Algid malaria: 1. As chloroquine-resistant cases are not endemic in
1 . Clinically resembles septic shock; may be as- this region, initial treatment should be: chloro-
sociated with hypothemia. quine phosphate, I gm orally, then 500 mg at 6
2. Treatment is directed at overall infection; in- hours, 24 hours and 48 hours.
travascular volume replacement, vasopressors, and 2. Depending on response, prophylaxis can than be
antibiotics should be added to the antimalarial resumed; or patient can be evacuated, and terminal
regimen, as needed. prophylaxis given if needed.
D. Renal Failure@ B. Alternatives:
I . May be pre-renal or intrarenal (ATN-like) in I . Critically ill patients who require IV medication
origin. can receive:
2. Treatment: a. Quinidine glucanate, 10 mg/kg (max 600 mg)
a. assure adequate intravascular volume re- loading dose over I to 2 hrs, followed by
nute constant infusion for a
b. supportive care to include dialysis if maximum of 72 hrs. Monitor EKG and switch to
needed. oral agents when mental status clears and
parasitemia < 1%.
E. Adult respiratory distress syndrome (ARDS; non-cardio- b. Quinidine gluconate, 15 mg/kg (max 650 kg)
genic pulmonary edema): loading dose over 4 hours; followed by 7.5
1. Pathogenesis: due to increased capillary per- mg/kg over 4 hours QBh for 7 days. Monitor
meability and fluid extravasation. Avoiding EKG and switch to oral agents as above.
excessive intravascular fluid administration may C. Quinine dihydrochloride, 650 mg IV, over 4
reduce incidence. hours, Q8h for 7 days. switch to oral agents
2. Treatment is supportive, to include mechanical as above.
ventilation. C. Treatment failures or early recrudescence:
F. Splenic rupture/hemorrhage: 1. IV regimen of quinine or quinidine as above, or
I- Treatment is blood replacement and control of 2. Quinine sulfate, 650 mg TID for 3 days, orally,
ne-sulfadoxine (Fansidar)
3 tablets in one dose; or tetracycline, 250 mg QID
for 7 days; or clindamycin, 900 mg TID for 3 days,
or
40 41
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996