Oral Presentation First Malaria World Congress 2018

Fluid Resuscitation in adult severe malaria: how dry can you go? (#179)

Haruhiko Ishioka 1
  1. Saitama Medical Center Jichi Medical University, Saitama, SAITAMA, Japan

The optimum fluid management in severe malaria has yet to be established, particularly in resource poor settings where access to mechanical ventilation is limited. Whilst liberal fluid resuscitation appears deleterious in severe malaria, it is not clear what the minimum fluid requirements are. In a prospective observational study in adults with severe falciparum malaria in Bangladesh and India, cumulative fluid administration and fluid balance were longitudinally monitored and correlated with changes in renal function (plasma creatinine), tissue perfusion (plasma lactate), and incidence of hypotension or pulmonary edema. The results show that despite common intravascular dehydration in patient with severe malaria, conservative fluid management of 2 to 3 mL/kg/hour without fluid bolus therapy is not related to deterioration of tissue perfusion or renal function, and is not associated with an increased incidence of hypotension. This suggests that the sequestered parasite biomass in the microcirculation, and not hypovolemia, is the main contributor to compromised tissue perfusion in severe malaria. Restrictive fluid management is recommended in patients with severe malaria. This does not apply to the minority of patients presenting with hypotensive shock.