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Filariasis Malaria Dengue JE


Management of JE is only symptomatic. The proposal of treatment is to maintain fluid eletrolyte balance, control temperature, convulsions and reduce intracranial pressure.
  • Fluid Elecrolyte balance
  • Temperature
  • Convulsions
  • Intracranial pressure
Fluid Elecrolyte balance

  • Intravenous fluids-Isolyte P-2/3rd to 3/4th of the maintenance with allowance of temperature, hyperventilation, and urine output.
  • For every 10C above basal body temperature, increase maintenance by 12%.
  • For hyperventilation, add 50-60 ml/100 kcal of energy used.
  • If the urine output is more than 50% of the total input, then add the excess fluid to the maintenance.
Temperature

  • Tepid sponging
  • Enteral paracetamol-60mg/kg/d-divided doses every 4-6 hourly
Convulsions

  • sedation with diazepam 0.1-0.3 mg/kg/dose
  • PHENYTOIN: Loading dose 15-20 mg/kg to be isfused at a rate of 0.5-1.5 mg/kg/min. Maintenance dose - 5-8 mg/kg/d. If the seizures persist, then another loading dose of phenobarbitone 10mg/kg can be given.
  • DIAZEPAM INFUSION: If the seizures still persists, then diazepam infusion to be started at a rate of not more than 5 mg/min followed by infusion at rate of 0.1-0.4 mg/kg/hr. Diluents to be used - sterile water, normal saline. If the seizures are yet to be controlled, then any of the following options can be tried.
  • MIDAZOLAM INFUSION: loading dose of 0.05-0.2 mg/kg stat followed by infusion at a rate of 1-5 g/kg/min.
Intracranial pressure

  • MANNITOL:Initial bolus to be given over 30 min, after stabilizing the vital signs.
    DOSE: 2.5-ml/kg of 20% solution (0.5-1 g/kg)
    Repeat mannitol to be given only if serum osmolality is <=300 mOm/kg.
    Repeat doses of mannitol can be given every 4-6 hourly, at a dose of 2.5ml/kg, given over 30 minutes.

  • FUROSEMIDE: The ICP to be reassessed about 30 min after giving mannitol. If the intracranial hypertension persists, inj. furosemide 1mg/kg/dose every 12th hrly can be given (potassium levels & blood pressure to be monitored while giving diuretics.

  • HYPERVENTILATION: can be done with bag and mask ventilation or after intubation. To decrease further rise in ICPduring intubation either 4% lignocaine as local spray or intravenous lignocaine at 1 mg/kg/dose slow IV can be used. When hyperventilation is used for the management of raised ICP, then aim is to achieve a Paco2 of 25mmhg.
    The level of PCO2 should ne raised to 30-35 mm hg after 1 hr.

  • THIOPENTONE: To be used when the above measures fail, but can be combined with hyperventilation. Dosage: loading dose of 5 mg/kg given over 30 - 60 min with a maintenance dose of 1 mg/kg/hr as infusion. Maximum maintenance dose is 5 mg/kg/hr. Whenever the maintenance dose is increased by 1 mg/kg/hr, a loading dose of 5 mg/kg to be given.

MONITORING

  • Blood pressure-hourly-maintain at 0.5 ml/hr
  • Urine output every 4 hourly - maintain at 0.5 ml/kg/hr
  • Serum osmolality - every 24 hourly (preferably every 12 hrly)     Formula for calculation of serum osmolality
    S.osmolality (mOsm/kg)
    = 2x Na(meq/L +Sugar(mg/dl)  +  Blood urea (mg/dl)
                             -----------------      --------------------------                               18                         6
  • Hourly SpO2 Central venous pressure for severe coma, whenever possible.

Malaria
Introduction
JE Distribution - World
Indian Scenario
Clinical Features
Diagnosis
Management of JE
JE Virus
Virus - Life cycle
Vector Mosquito
Vector mosquito - Life cycle
Control of vector mosquito
Control Strategies

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