Pediatric emergency medicine trisk 2381 2381

Species Predominant region P falciparum Africa Indian subcontinent Papua New Guinea Southeast Asia Southern Central America Northern South America Haiti P malariae Sub-Saharan Africa Southeast Asia Complications Hypoglycemia: the most common complication of severe malaria; symptoms of hypoglycemia can be difficult to differentiate from malaria symptoms (altered mentation, diaphoresis, tachycardia) Cerebral malaria: altered mentation, seizures, encephalopathy, retinal hemorrhages; focal neurologic signs are rare; CSF demonstrates mild pleocytosis, slightly elevated CSF protein, and very low CSF glucose Respiratory distress can be caused by noncardiogenic pulmonary edema/ARDS (due to malaria itself or fluid overload after resuscitation) or to compensatory respiratory alkalosis to compensate for metabolic acidosis Renal failure (acute tubular necrosis, interstitial nephritis, glomerulonephritis; “blackwater fever” with urinary discoloration from hemoglobinuria) Shock: hypovolemic and/or due to severe anemia Hepatic dysfunction: icterus with or without hepatorenal syndrome; coagulopathy, transaminitis, cholestasis, and both conjugated and unconjugated hyperbilirubinemia may be seen Congenital malaria: risk is increased in mothers with HIV infection Anemia Chronic asymptomatic parasitemia Nephrotic syndrome