title: The Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria.
abstract: BACKGROUND
  A conservative approach to fluid resuscitation improves survival in children with severe malaria; however, this strategy has not been formally evaluated in adults with the disease.
  
  
  METHODS
  Adults hospitalised with malaria at two tertiary referral hospitals in Myanmar received intravenous fluid replacement with isotonic saline, administered at a maintenance rate using a simple weight-based algorithm. Clinical and biochemical indices were followed sequentially.
  
  
  RESULTS
  Of 61 adults enrolled, 34 (56%) had Plasmodium falciparum mono-infection, 17 (28%) Plasmodium vivax mono-infection and 10 (16%) mixed infection; 27 (44%) patients were at high risk of death (P. falciparum infection and RCAM score ≥ 2). In the first six hours of hospitalisation patients received a mean 1.7 ml/kg/hour (range: 1.3-2.2) of intravenous fluid and were able to drink a mean of 0.8 ml/kg/hour (range: 0-3). Intravenous fluid administration and oral intake were similar for the remainder of the first 48 hours of hospitalisation. All 61 patients survived to discharge. No patient developed Adult Respiratory Distress Syndrome, a requirement for renal replacement therapy or hypotension (mean arterial pressure < 60 mmHg). Plasma lactate was elevated (> 2 mmol/L) on enrolment in 26 (43%) patients but had declined by 6 hours in 25 (96%) and was declining at 24 hours in the other patient. Plasma creatinine was elevated (> 120 μmol/L) on enrolment in 17 (28%) patients, but was normal or falling in 16 (94%) at 48 hours and declining in the other patient by 72 hours. There was no clinically meaningful increase in plasma lactate or creatinine in any patient with a normal value on enrolment. Patients receiving fluid replacement with the conservative fluid replacement algorithm were more likely to survive than historical controls in the same hospitals who had received fluid replacement guided by clinical judgement in the year prior to the study (p = 0.03), despite having more severe disease (p < 0.001).
  
  
  CONCLUSIONS
  A conservative fluid resuscitation strategy appears safe in adults hospitalised with malaria.
authors.affiliation: Insein General Hospital, Yangon, Myanmar.
authors.forename: Ne Myo
authors.initials: NM
authors.lastname: Aung
authors.affiliation: Hpa-an Hospital, Hpa-an, Kayin State, Myanmar.
authors.forename: Myat
authors.initials: M
authors.lastname: Kaung
authors.affiliation: Insein General Hospital, Yangon, Myanmar.
authors.forename: Tint Tint
authors.initials: TT
authors.lastname: Kyi
authors.affiliation: Department of Medical Research (Lower Myanmar), Yangon, Myanmar.
authors.forename: Myat Phone
authors.initials: MP
authors.lastname: Kyaw
authors.affiliation: Myanmar Medical Association, Yangon, Myanmar.
authors.forename: Myo
authors.initials: M
authors.lastname: Min
authors.affiliation: Insein General Hospital, Yangon, Myanmar.
authors.forename: Zaw Win
authors.initials: ZW
authors.lastname: Htet
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.affiliation: Insein General Hospital, Yangon, Myanmar.
authors.forename: Mar Mar
authors.initials: MM
authors.lastname: Kyi
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Josh
authors.initials: J
authors.lastname: Hanson
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood; D000284:Administration, Oral; D000328:Adult; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D004573:Electrolytes / Q000097:blood; D005440:Fluid Therapy / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D007773:Lactates / Q000097:blood; D008288:Malaria / Q000097:blood / Q000401:mortality / Q000628:therapy*; D002052:Myanmar / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D004573:Electrolytes; D007773:Lactates; D003404:Creatinine