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."
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.

Sanjeev Krishna
St. George's Hospital Medical School
London, UK
+44-(020)-8725-3487 (fax)


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

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


Related Malaria Articles from Brightsurf:

Clocking in with malaria parasites
Discovery of a malaria parasite's internal clock could lead to new treatment strategies.

Breakthrough in malaria research
An international scientific consortium led by the cell biologists Volker Heussler from the University of Bern and Oliver Billker from the UmeƄ University in Sweden has for the first time systematically investigated the genome of the malaria parasite Plasmodium throughout its life cycle in a large-scale experiment.

Scientists close in on malaria vaccine
Scientists have taken another big step forward towards developing a vaccine that's effective against the most severe forms of malaria.

New tool in fight against malaria
Modifying a class of molecules originally developed to treat the skin disease psoriasis could lead to a new malaria drug that is effective against malaria parasites resistant to currently available drugs.

Malaria expert warns of need for malaria drug to treat severe cases in US
The US each year sees more than 1,500 cases of malaria, and currently there is limited access to an intravenously administered (IV) drug needed for the more serious cases.

Monkey malaria breakthrough offers cure for relapsing malaria
A breakthrough in monkey malaria research by two University of Otago scientists could help scientists diagnose and treat a relapsing form of human malaria.

Getting to zero malaria cases in zanzibar
New research led by the Johns Hopkins Center for Communication Programs, Ifakara Health Institute and the Zanzibar Malaria Elimination Program suggests that a better understanding of human behavior at night -- when malaria mosquitoes are biting -- could be key to preventing lingering cases.

Widely used malaria treatment to prevent malaria in pregnant women
A global team of researchers, led by a research team at the Liverpool School of Tropical Medicine (LSTM), are calling for a review of drug-based strategies used to prevent malaria infections in pregnant women, in areas where there is widespread resistance to existing antimalarial medicines.

Protection against Malaria: A matter of balance
A balanced production of pro and anti-inflammatory cytokines at two years of age protects against clinical malaria in early childhood, according to a study led by ISGlobal, an institution supported by ''la Caixa'' Foundation.

The math of malaria
A new mathematical model for malaria shows how competition between parasite strains within a human host reduces the odds of drug resistance developing in a high-transmission setting.

Read More: Malaria News and Malaria Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to