Notice to ships' surgeons : suggestions for the prevention, diagnosis and treatment of malaria / [Ministry of Transport].

  • Great Britain. Ministry of Transport
Date:
[1949]
Catalogue details

Licence: Public Domain Mark

Credit: Notice to ships' surgeons : suggestions for the prevention, diagnosis and treatment of malaria / [Ministry of Transport]. Source: Wellcome Collection.

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    occurrence of pigmented asexual forms of P. falciparum in the peripheral blood ; (5) hyperpyrexia ; (6) algid or collapsed conditions ; (7) severe bilious or untractable vomiting, or other cause preventing the retention or absorption of the drug by the oral route ; (8) paroxysm after paroxysm not cut short by adequate oral treatment. Intravenous injections of quinine, especially if given too quickly and in concentrated solutions, may sometimes cause a rapid fall in blood pressure with collapse. Special care should be taken in patients with organic disease of the heart, marked anaemia and debility, and severe jaundice. Injections are better given when the stomach is not full. Errors in technique may also give rise to local necrosis and thrombosis in the vein. When proper precautions are taken, these risks are relatively slight, and are greatly out-weighed by the life-saving effects of such injections. 3 The dosage is 74-10 grains of quinine dihydrochloride or dihydrobro- mide at one injection. When possible this should be given as a transfusion in a large amount of fluid (200-300 cc.), but, if facilities for immediate transfusion be not available, the initial dose may be given in 10-20 ccs. fluid (vide Appendix No. 1). This dosage may be repeated in 6-8 hours, if the patient’s condition demands it, and adequate oral administration cannot be started. Usually a single injection is sufficient to enable oral. administration to begin. Not more than 30 grains of quinine should be given parenterally in 24 hours, but the patient should, however, receive and retain at least a total of 30 grains daily, irrespective of the routes used. (5) Intramuscular Injections of Mepacrine or Quinine. Intramuscular medication has no special virtue over oral treatment, when the latter can be employed and the drug is absorbed. Indeed in the case of quinine the rate of absorption after oral administration is more rapid. Such injections always cause a greater or less degree of necrosis at the site of the injection. Apart from damage to muscles resulting in septic or aseptic abcesses, if any important nerves or vessels are involved very serious results may follow. Quinine is believed to be much more destructive than is mepacrine by this route, so that the latter should be used when this method becomes necessary. Such injections cannot replace intravenous medication with quinine in urgent emergencies. They may, however, be used to reinforce or supplement the latter and maintain their action, or be substituted for them when for technical or other reasons it is not possible, or desirable, to use intravenous quinine medication. _ The chief indications for the use of intramuscular injections are :— (i) where it is not possible for technical reasons to find a suitable vein for intravenous injection, when that method is indicated (vide supra) ; (ii) sometimes in very collapsed patients with circulatory weakness when facilities for intravenous injection of quinine diluted with large amounts