Associations between restrictive fluid management and renal function and tissue perfusion in adults with severe falciparum malaria - a prospective observational study.
Ishioka H., Plewes K., Pattnaik R., Kingston HWF., Leopold SJ., Herdman MT., Mahanta K., Mohanty A., Dey C., Alam S., Srinamon K., Mohanty A., Maude RJ., White NJ., Day NPJ., Hossain MA., Faiz MA., Charunwatthana P., Mohanty S., Ghose A., Dondorp AM.
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, of whom 41 (26.6%) died. Median (interquartile range, IQR) total fluid intake during first 6 and 24 hours from enrolment was 3.3 (1.8-5.1) mL/kg/hour and 2.2 (1.6-3.2) mL/kg/hour respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n=116; rs=0.16; P = 0.089) or lactate at 6 hours (n = 94, rs = -0.05, P = 0.660). Development of hypotensive shock or pulmonary edema within 24 hours after enrolment were not related to the volume of fluid administration. CONCLUSION: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/hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.