Table 1 WHO guideline for complicated malaria

Clinical features

- Impaired consciousness: Glasgow Coma Scale <11 in adults or Blantyre coma score <3 in children

- Prostration

- Multiple convulsion: >2 episodes within 24 h

- Respiratory distress

- Pulmonary edema: radiologically confirmed or oxygen saturation <92 % in room air with a respiratory rate >30/min

- Significant bleeding: including recurrent or prolonged bleeding from the nose, gums, and venipuncture sites; hematemesis or melena

- Shock

Laboratory findings

- Metabolic acidosis: plasma bicarbonate <15 mmol/L or venous plasma lactate ≥5 mmol/L

- Hypoglycemia: blood glucose <2.2 mmol/L or 40 mg/dL

- Severe malarial anemia: Hb <5 g/dL, Hct ≤15 % in children (<12 years of age) with parasite >10,000/μL; Hb <7 g/dL, Hct ≤20 % in adults with parasite >10,000/μL

- Renal impairment: plasma or serum creatinine >265 μmol/L (3 mg/dL) or blood urea >20 mmol/L

- Jaundice: plasma or serum bilirubin >50 μmol/L (3 mg/dL) with parasite count >10,000/μL

- Hyperparasitemia: P. falciparum parasitemia >10 %