goodduck

[Severe Falciparum Malaria]
1. Why ?
-- 1000000 death around the world
-- nearly all death from Falciparum
2. What is severe malaria?
-- acute malaria with organ dysfunction or  infected RBC >3%
3. Who are at high risk?
-- In endemia area, young children (w/o develope partial immune after repeat infection)
-- Travellers (w/o immune)
4. How?(Pathogenesis)

5.Symptom and Sign (八陣圖)
a. brain -> cerebral edema -> generalized convulsion / impair conscious/ coma
-- microvascular cytoadherence of RBC
-- keypoint : meningeal sign(-) ; diffuse symetric encephalopathy
b. lung -> noncardiogenic edema  -> Tachypnea, labored deep breath
-- not clear; maybe microvascular cytoadherence of RBC
-- mortality >80%
c.. kidney -> acute renal failure / ATN ->  Fluid/electrolyte abnormality
-- microvascular cytoadherence of RBC
-- tubular necrosis, never cortex necrosis
d. liver -> hepatocyte damage -> jaundice / hypoglycemia / lactic acidosis
e. hematologic -> anemia / coagulopathy

6. Lab
CBC/DC
a. severe normochromic/normocytic anemia
b. leukocytosis
c. coagulopathy 
Biochemistry
a. lactic acidosis
-- increase: anaerobic glycolysis(microvascular sequestration of RBC)
                      hypovolemia
    decrease: liver and kidney clearance
-- prognosis indicator -> lactate / bicarbonate
b. hypoglycemia
-- source decrease: liver dysfunction -> gluconeogenesis decrease 
    consumption: host(more) + parasite(less)
-- quinine->insulin secretion(powerful)->compound hypoglycemia!
c. jaundice
-- combine : hemolysis + hepatocyte injury + cholestasis 


Others
1. 4/25
2. 體溫上升攝氏一度 -> CO2增加13% (from ganong)