Getting the fluid balance right in malaria

October 18, 2004

Every year around a million people, mainly small children, die of malaria. Dehydration is thought to contribute to fatal cases of the disease and, hence, doctors often give fluids to treat very ill children. However, research published on October 19, 2004, in the new open access journal PLoS Medicine suggests that children with severe malaria may not be as badly dehydrated as was previously thought. "This challenges the view that dehydration is a major contributor to the pathology of this frequently lethal disease," says Nick White (Mahidol University, Thailand), who was not involved in the study.

Until now, research efforts have been hampered because scientists did not have an easy way to assess the amount of fluid depletion in the body; ideally, scientists should be able to measure how much water is contained within the body's cells and how much water lies outside them. Sanjeev Krishna and colleagues from St George's Hospital Medical School, London, UK, have developed new techniques that allow these two volumes to be measured, along with the total body water. They used these techniques to measure fluid volumes in 35 children with moderate-to-severe malaria who lived in Gabon and found that none of the children were severely dehydrated.

So, based on these data--obtained from a carefully studied, albeit small, group of children--what should people who treat children with malaria do? The researchers recommend that clinicians should think again about how vigorously they replace fluid in children with malaria, and suggest that if a doctor has access to ways of assessing fluid volume more precisely, they should do so (not a trivial undertaking in many hospitals where these children are treated). "The optimum resuscitation approach in severe childhood malaria remains to be defined," says White. "The relative advantages of blood, colloids, and crystalloids need to be characterized."
-end-
Citation: Planche T, Onanga M, Schwenk A, Dzeing A, Borrmann S, et al. (2004) Assessment of Volume Depletion in Children with Malaria. PLoS Med 1 (1): e18.

CONTACT:
Sanjeev Krishna
St. George's Hospital Medical School
London, UK
+44-(020)-8725-5836
+44-(020)-8725-3487 (fax)
s.krishna@sghms.ac.uk

PLEASE MENTION PLoS MEDICINE (www.plosmedicine.org) AS THE SOURCE FOR THIS ARTICLE. THANK YOU.

All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere--to read, download, redistribute, include in databases, and otherwise use--subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.

About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org

PLOS

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