Research suggests that children with severe malaria may not be as badly dehydrated as was previously thought

Nov 4 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 in October 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. Professor Sanjeev Krishna and colleagues from St George’s Hospital Medical School, Department of Cellular and Molecular Medicine, 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. The researchers found that none of the children were severely dehydrated and that only three of the children who had severe anemia, a characteristic of malaria, also had fluid depletion.

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.”

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