Assessment of Volume Depletion in Children with Malaria

Timothy Planche,Jean-François Faucher,Leigh Ward,Myriam Onanga,Arnaud Dzeing,Achim Schwenk,Maryvonne Kombila,Steffen Borrmann,Peter G Kremsner,Sanjeev Krishna,Antony Wright,Les Bluck

doi:10.1371/journal.pmed.0010018

Abstract

ABSTRACTBackgroundThe 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.

Highlights

Malaria claims one million lives annually, with more than 90% of these being those of children in sub-Saharan Africa [1]
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
Children admitted with suspected severe or moderate malaria were referred to the study team, who assessed them within 15 min, and the children were admitted to the study once informed consent had been obtained from the parents

Summary

Introduction

Malaria claims one million lives annually, with more than 90% of these being those of children in sub-Saharan Africa [1]. In east African studies, clinical signs of severe malaria (such as tachycardia, prolonged capillary refill times, and decreased urine volume) have been interpreted as evidence for volume depletion [2,3,4,5,6]. Our study was designed to measure total body water volume (TBW) and extracellular water volume (ECW) using nonradioactive tracer dilution techniques and to derive intracellular water volume (ICW). The degree of volume depletion in severe malaria is currently unknown, 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. The researchers studied children who were sick with malaria and measured how dehydrated the children were. Neither technique suggested that any of the children were severely dehydrated

Methods

Results

Conclusion