Assessment of volume depletion in children with malaria.
BACKGROUND
The 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.


RESULTS
Total 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.


CONCLUSIONS
Significant 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.
Planche
Timothy
T
Department of Cellular and Molecular Medicine, Infectious Diseases, St. George's Hospital Medical School, London, United Kingdom.
Onanga
Myriam
M
Schwenk
Achim
A
Dzeing
Arnaud
A
Borrmann
Steffen
S
Faucher
Jean-François
JF
Wright
Antony
A
Bluck
Les
L
Ward
Leigh
L
Kombila
Maryvonne
M
Kremsner
Peter G
PG
Krishna
Sanjeev
S
D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D020896:Hypovolemia / Q000209:etiology* / Q000628:therapy*; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D012016:Reference Values; D012720:Severity of Illness Index; D014882:Water-Electrolyte Balance