<s>[INST] context: Cerebral malaria

Many adjuvant therapies have been suggested based on the prevailing pathophysiology and hypothesis of the time.
These include heparin, low molecular weight dextran, urea, high dose corticosteroid, aspirn, prostacycline, pentoxifflline, desferioxamine, anti TNF antibody, cyclosporin and hyperimmune serum.
Unfortunately, none have proved beneficial and several have proved harmful none of these adjuvants should be used, the cornerstone of management is good intensive care and correct antimalarial treatment.

Management of cerebral malaria
Antimalarial treatment

In cerebral malaria rapidly acting parenteral drugs should be given. Quinine is the drug of choice.

Fluid balance

Following admission patient should be rehydrated to a CVP of approximately 5 cm

Hypoglycemia

Slow intravenous injection of 50% dextrose water

Lactic acidosis

Hypovolemia should be corrected first

Acute renal failure

Fluid should be restricted to replace insensible losses only. Dialysis should be started early when there is evidence of multiple organ dysfunction.

Acute pulmonary edema

They should be nursed upright and given oxygen and the right-sided filling pressure should be reduced

Bleeding

Less than 5% of patients of cerebral malaria develop D.I.C. These patients should be given a fresh blood transfusion and vitamin K.

Bacterial superinfection / continued fever

Patient with secondary pneumonia should be given empirical treatment with a third-generation cephalosporin. [/INST] question: In complication of falciparum malaria, which drug is not given - | options: A: Phenobarbitone B: Dexmethosone C: Quinine D: Blood transfusion | answer: B </s>