| Test | Result | Ref | Δ | When |
|---|---|---|---|---|
| Haemoglobin | 7.8 g/dL | 13.5-17.5 | 5 hours ago | |
| WBC | 12.4 ×10³/µL | 4.5-11.0 | — | 5 hours ago |
| Platelets | 85 ×10³/µL | 150-400 | 5 hours ago | |
| Creatinine | 106 µmol/L | 62-115 | — | 5 hours ago |
| Malaria Smear | Positive | Negative | — | 8 hours ago |
| Drug | Dose | Route | Frequency |
|---|---|---|---|
| Artesunate | 2.4 mg/kg | IV | 0h, 12h, 24h then q24h |
| Paracetamol | 1000 mg | IV | q6h PRN |
| Normal Saline | 1000 mL | IV | Continuous |
| Order | Status | Priority | Ordered |
|---|---|---|---|
| Full Blood Count (FBC) | completed | stat | 5 hours ago |
| Malaria Smear | completed | stat | 8 hours ago |
Patient presents with 3-day history of fever, chills, and severe fatigue following travel to endemic region. Initial malaria smear positive. Starting IV artesunate per WHO severe malaria protocol.
AssistantAIPatient Summary: John K.
58-year-old male with severe malaria, admitted 3 days ago.
Key Findings:
- Haemoglobin dropped from 10.2 to 7.8 g/dL (critical)
- Platelets declining: 142 → 85 ×10³/µL
- Malaria smear positive
- Febrile (39.2°C), tachycardic (112 bpm)
- Hypotensive (BP 102/68) — WHO severity criterion met
- SpO2 94% on room air — supplemental O2 indicated
Active Treatment:
- Artesunate IV 2.4 mg/kg (0h, 12h, 24h then q24h)
- IV fluids ongoing
Recent Labs: FBC performed 5 hours ago | Blood glucose not yet checked
Falling Haemoglobin Alert
Haemoglobin has dropped 24% in the past 24 hours (10.2 → 7.8 g/dL).
Consider:
- Monitoring for signs of haemolysis
- Assessing need for blood transfusion (threshold <7.0 g/dL or haemodynamic compromise)
- Reviewing fluid status
Haemodynamic Instability — Severity Criterion
BP 102/68 mmHg (hypotension) and HR 112 bpm indicate circulatory compromise.
This meets WHO criteria for severe malaria (SBP <100 mmHg).
Consider:
- Cautious IV fluid resuscitation (avoid fluid overload in malaria)
- Monitor urine output (target >0.5 mL/kg/h)
- ICU-level monitoring
Hypoxaemia — Severity Criterion
SpO2 94% on room air. Respiratory compromise meets WHO severe malaria criteria.
Consider:
- Supplemental oxygen to maintain SpO2 ≥95%
- Assess for pulmonary oedema (complication of IV fluids in severe malaria)
- Repeat respiratory rate — currently 22/min (tachypnoea)
Hypoglycaemia Risk
Artesunate and severe malaria itself are both associated with hypoglycaemia.
Recommend:
- Blood glucose monitoring q4h
- Current glucose not yet checked — order urgently