Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study

Haruhiko Ishioka, Katherine Plewes, Rajyabardhan Pattnaik, Hugh W. F. Kingston, Stije J. Leopold, M. Trent Herdman, Kishore Mahanta, Anita Mohanty, Chandan Dey, Shamsul Alam, Ketsanee Srinamon, Akshaya Mohanty, Richard J. Maude, Nicholas J. White, Nicholas P. J. Day, Md Amir Hossain, Md Abul Faiz, Prakaykaew Charunwatthana, Sanjib Mohanty, Aniruddha GhoseArjen M. Dondorp

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14 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)285-292
Number of pages8
JournalJournal of infectious diseases
Volume149
Issue number2
DOIs
Publication statusPublished - 1 Dec 2019

Keywords

  • acute kidney injury
  • pulmonary edema
  • restrictive fluid management
  • severe malaria
  • tissue perfusion

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