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The fluid management of adults with severe malaria

Hanson, Josh, Anstey, Nicholas M., Bihari, David, White, Nicholas J., Day, Nicholas P. J. and Dondorp, Arjen M. (2014). The fluid management of adults with severe malaria. Critical Care,18(6 - Article No. 642).

Document type: Journal Article
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IRMA ID 84473293xPUB145
Title The fluid management of adults with severe malaria
Author Hanson, Josh
Anstey, Nicholas M.
Bihari, David
White, Nicholas J.
Day, Nicholas P. J.
Dondorp, Arjen M.
Journal Name Critical Care
Publication Date 2014
Volume Number 18
Issue Number 6 - Article No. 642
ISSN 1364-8535   (check CDU catalogue  open catalogue search in new window)
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Fluid resuscitation has long been considered a key intervention in the treatment of adults with severe falciparum malaria. Profound hypovolemia is common in these patients and has the potential to exacerbate the acidosis and acute kidney injury that are independent predictors of death. However, new microvascular imaging techniques have shown that disease severity correlates more strongly with obstruction of the microcirculation by parasitized erythrocytes - a process termed sequestration. Fluid loading has little effect on sequestration and increases the risk of complications, particularly pulmonary edema, a condition that can develop suddenly and unpredictably and that is frequently fatal in this population. Accordingly, even if a patient is clinically hypovolemic, if there is an adequate blood pressure and urine output, there may be little advantage in infusing intravenous fluid beyond a maintenance rate of 1 to 2 mL/kg per hour. The optimal agent for fluid resuscitation remains uncertain; significant anemia requires blood transfusion, but colloid solutions may be associated with harm and should be avoided. The preferred crystalloid is unclear, although the use of balanced solutions requires investigation. There are fewer data to guide the fluid management of severe vivax and knowlesi malaria, although a similar conservative strategy would appear prudent.
DOI http://dx.doi.org/10.1186/s13054-014-0642-6   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License
URL https://creativecommons.org/licenses/by/4.0/au


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