Assessment of volume depletion in children with malaria

Planche, Timothy, Onanga, Myriam, Schwenk, Achim, Dzeing, Arnaud, Borrmann, Steffen, Faucher, Jean-François, Wright, Antony, Bluck, Les, Ward, Leigh, Kombila, Maryvonne, Kremsner, Peter G. and Krishna, Sanjeev (2004) Assessment of volume depletion in children with malaria. Plos Medicine, 1 1: 56-63. doi:10.1371/journal.pmed.0010018

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Author Planche, Timothy
Onanga, Myriam
Schwenk, Achim
Dzeing, Arnaud
Borrmann, Steffen
Faucher, Jean-François
Wright, Antony
Bluck, Les
Ward, Leigh
Kombila, Maryvonne
Kremsner, Peter G.
Krishna, Sanjeev
Title Assessment of volume depletion in children with malaria
Journal name Plos Medicine   Check publisher's open access policy
ISSN 1549-1277
Publication date 2004-10-01
Sub-type Article (original research)
DOI 10.1371/journal.pmed.0010018
Open Access Status DOI
Volume 1
Issue 1
Start page 56
End page 63
Total pages 8
Place of publication USA
Publisher Public Library of Science
Language eng
Subject C1
321099 Clinical Sciences not elsewhere classified
730199 Clinical health not specific to particular organs, diseases and conditions
Abstract 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. Methods and Findings 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 and bioelectrical impedance analysis measurements were taken daily against dilution methods, 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.
Keyword Medicine, General & Internal
Acute Falciparum-malaria
Kenyan Children
Q-Index Code C1
Additional Notes Copyright: © 2004 Planche et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Created: Wed, 15 Aug 2007, 13:45:18 EST