Assessment of Volume Depletion in Children with Malaria

Abstract

BackgroundThe degree of volume depletion in severe malaria is currently unknown, although knowledge of fluid compartment volumes can guide therapy. To assist management of severely ill children, and to test the hypothesis that volume changes in fluid compartments reflect disease severity, we measured body compartment volumes in Gabonese children with malaria.Methods and FindingsTotal body water volume (TBW) and extracellular water volume (ECW) were estimated in children with severe or moderate malaria and in convalescence by tracer dilution with heavy water and bromide, respectively. Intracellular water volume (ICW) was derived from these parameters. Bioelectrical impedance analysis estimates of TBW and ECW were calibrated against dilution methods, and bioelectrical impedance analysis measurements were taken daily until discharge. Sixteen children had severe and 19 moderate malaria. Severe childhood malaria was associated with depletion of TBW (mean [SD] of 37 [33] ml/kg, or 6.7% [6.0%]) relative to measurement at discharge. This is defined as mild dehydration in other conditions. ECW measurements were normal on admission in children with severe malaria and did not rise in the first few days of admission. Volumes in different compartments (TBW, ECW, and ICW) were not related to hyperlactataemia or other clinical and laboratory markers of disease severity. Moderate malaria was not associated with a depletion of TBW.ConclusionsSignificant hypovolaemia does not exacerbate complications of severe or moderate malaria. As rapid rehydration of children with malaria may have risks, we suggest that fluid replacement regimens should aim to correct fluid losses over 12–24 h.

Severe Malaria Anaemia in Children

“…The reduced body water and intravascular space also contribute to tachycardia. In one study, severe malaria was found to be associated with about 6.7% reduction in total body water, a loss, marginally greater than values for mild dehydration such that overzealous volume expansion may be detrimental (Planche et al, 2004) Increased insensible loss from pyrexia, sweating and tachypnea are contributory factors to fluid loss in the study population. Despite the longer duration of illness and prominence of tachypnea, many of the children with severe malaria anaemia showed no or minimal signs of dehydration.…”

“…(Maitland et al, 2003) Severe malaria has been found to be associated with about 6.7% reduction in total body water, a loss slightly more than mild dehydration such that overzealous volume expansion may be detrimental. (Planche et al, 2004) Blood transfusion is fraught with many risks of immediate and long term complications which must be weighed against their potential benefits. Such risks include transmission of infections including HIV, Hepatitis, Ebstein Barr, cytomegalovirus and other pathogens in screened and unscreened blood.…”

Malaria: progress, perils, and prospects for eradication

“…Retinal changes occur in many patients with severe malaria, and a specific pathology was recently described that might aid diagnosis (30). Children with severe malaria rarely present with the classical features of circulatory shock, but recent studies have suggested, controversially, that many have hypovolemia that contributes to their acidosis (31,32).…”

Perioperative considerations of the patient with malaria

“…Volume depletion is usually not the main problem, and there is the risk of precipitating pulmonary and cerebral edema. 72,73 Fever is a common clinical feature of malaria. The temperature, particularly in non-immune individuals, may rise above 40°C and can be associated with significant tachycardia, tachypnea, and sweating.…”