The patient should be admitted to an intensive care unit. At admission if the temperature is very high immediate cool sponging should be undertaken. Vital parameters should be assessed and blood should be sent for the tests mentioned earlier. An intravenous access line should be established. If a shock state is encountered, rapid fluid administration and vasopressor agents are indicated.
Anaemia is almost always present.
Seizures respond well to 5-10 mg of diazepam. It may, however, worsen the already compromised respiratory status and ventilatory support should be handy. Recurrent seizures need antiepileptic therapy with phenytoin or phenobarbitone. Corticosteroids, once used extensively, should not be used as they have been shown in randomised trials to be of no benefit. The specific management of cerebral malaria has been dealt with in other sections of this issue.