• K Maitland, M Levin, M English, S Mithwani, N Peshu, K Marsh, and C R J C Newton.
• Centre for Geographic Medicine Research, Coast, KEMRI/Wellcome Trust Unit, P.O. Box 230, Kilifi, Kenya. kmaitland@kilifi.mimcom.net
• QJM. 2003 Jun 1;96(6):427-34.

BackgroundThe role of volume resuscitation in severe Plasmodium falciparum malaria is controversial.AimTo examine the role of hypovolaemia in severe childhood malaria.Study DesignRetrospective review.MethodsWe studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination.ResultsFactors associated with a fatal outcome included deep breathing or acidosis (base excess below -8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 micro mol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (chi(2) = 14.9; p = 0.001).DiscussionImpaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.

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