Hyponatremia may occur. Diagnosis Diagnosis requires a high index of suspicion and demonstration of malarial parasites in the peripheral blood. Smears should be obtained initially every 6-8 hours while the diagnosis is in question for at least 3 days. Smears should be followed every 8-12 hours, if seriously ill, to monitor the effects of therapy and then daily until parasitemia is resolved. Trophozoites should ideally decrease by 75 percent in first 48 hours and disappear within 7 days although gametes may persist.
Thin smears are an alternative if the lab is unable to prepare and interpret thick smears .
Any significant cardiac or pulmonary dysfunction. Increased risk to mother and child. Cases of complicated malaria should be presumed to be secondary to P. falciparum and should be treated as a medical emergency with parenteral therapy initially . Only sensitive organisms are reliably found in Central America above Panama, Haiti, the Dominican Republic, and the Middle East. Mefloquine resistance has been widely reported from Southeast Asia and many parts of Africa.