Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study. (31st August 2019)

• Record Type: Journal Article
• Authors: Ishioka, Haruhiko; Plewes, Katherine; Pattnaik, Rajyabardhan; Kingston, Hugh W F; Leopold, Stije J; Herdman, M Trent; Mahanta, Kishore; Mohanty, Anita; Dey, Chandan; Alam, Shamsul; Srinamon, Ketsanee; Mohanty, Akshaya; Maude, Richard J; White, Nicholas J; Day, Nicholas P J; Hossain, Md Amir; Faiz, Md Abul; Charunwatthana, Prakaykaew; Mohanty, Sanjib; Ghose, Aniruddha; Dondorp, Arjen M
• Is Part Of: Journal of infectious diseases. Volume 221:Number 2(2020)
• Page Start: 285
• Page End: 292
• Publication Date: 2019-08-31
• Subjects: acute kidney injury -- tissue perfusion -- pulmonary edema -- restrictive fluid management -- severe malaria; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiz449
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined. Methods: In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated. Results: A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8–5.1) mL/kg per hour and 2.2 (IQR, 1.6–3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; r s = 0.16; P = .089) or lactate at 6 hours (n = 94; r s = −0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration. Conclusions: Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2–3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive. Abstract : The optimum fluid management in severe malaria has not been established. In this prospective observational study, restrictive fluid management did not impair kidney function and tissue perfusion, supporting the safety of this approach in adults with severe falciparum malaria.