Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia
K Maitland, M Levin, M English, S Mithwani, N Peshu… - Qjm, 2003 - academic.oup.com
Qjm, 2003•academic.oup.com
Background: The role of volume resuscitation in severe Plasmodium falciparum malaria is
controversial. Aim: To examine the role of hypovolaemia in severe childhood malaria. Study
design: Retrospective review. Methods: We studied 515 children admitted with severe
malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children
underwent a further assessment of vital signs and a standard clinical examination. Results:
Factors associated with a fatal outcome included deep breathing or acidosis (base excess …
controversial. Aim: To examine the role of hypovolaemia in severe childhood malaria. Study
design: Retrospective review. Methods: We studied 515 children admitted with severe
malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children
underwent a further assessment of vital signs and a standard clinical examination. Results:
Factors associated with a fatal outcome included deep breathing or acidosis (base excess …
Abstract
Background: The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial.
Aim: To examine the role of hypovolaemia in severe childhood malaria.
Study design: Retrospective review.
Methods: We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination.
Results: Factors associated with a fatal outcome included deep breathing or acidosis (base excess below –8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 μmol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (χ2 = 14.9; p = 0.001).
Discussion: Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.
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