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QJM. 2003 Jun;96(6):427-34.

Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia.

Author information

1
Centre for Geographic Medicine Research, Coast, KEMRI/Wellcome Trust Unit, P.O. Box 230, Kilifi, Kenya. kmaitland@kilifi.mimcom.net

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 micro mol/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 (chi(2) = 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.

PMID:
12788961
DOI:
10.1093/qjmed/hcg077
[Indexed for MEDLINE]

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