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The Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria

Aung, Ne Myo, Kaung, Myat, Kyi, Tint Tint, Kyaw, Myat Phone, Min, Myo, Htet, Zaw Win, Anstey, Nicholas M., Kyi, Mar Mar and Hanson, Josh (2015). The Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria. PLoS One,10(11 - Article No. e0143062).

Document type: Journal Article
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IRMA ID 10444xPUB10
NHMRC Grant No. 1042072
Title The Safety of a Conservative Fluid Replacement Strategy in Adults Hospitalised with Malaria
Author Aung, Ne Myo
Kaung, Myat
Kyi, Tint Tint
Kyaw, Myat Phone
Min, Myo
Htet, Zaw Win
Anstey, Nicholas M.
Kyi, Mar Mar
Hanson, Josh
Journal Name PLoS One
Publication Date 2015
Volume Number 10
Issue Number 11 - Article No. e0143062
ISSN 1932-6203   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84957922272
Total Pages 15
Place of Publication United States of America
Publisher Public Library of Science
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
A conservative approach to fluid resuscitation improves survival in children with severe malaria; however, this strategy has not been formally evaluated in adults with the disease.

Adults hospitalised with malaria at two tertiary referral hospitals in Myanmar received intravenous fluid replacement with isotonic saline, administered at a maintenance rate using a simple weight-based algorithm. Clinical and biochemical indices were followed sequentially.

Of 61 adults enrolled, 34 (56%) had Plasmodium falciparum mono-infection, 17 (28%) Plasmodium vivax mono-infection and 10 (16%) mixed infection; 27 (44%) patients were at high risk of death (P. falciparum infection and RCAM score ≥ 2). In the first six hours of hospitalisation patients received a mean 1.7 ml/kg/hour (range: 1.3–2.2) of intravenous fluid and were able to drink a mean of 0.8 ml/kg/hour (range: 0–3). Intravenous fluid administration and oral intake were similar for the remainder of the first 48 hours of hospitalisation. All 61 patients survived to discharge. No patient developed Adult Respiratory Distress Syndrome, a requirement for renal replacement therapy or hypotension (mean arterial pressure < 60mmHg). Plasma lactate was elevated (> 2 mmol/L) on enrolment in 26 (43%) patients but had declined by 6 hours in 25 (96%) and was declining at 24 hours in the other patient. Plasma creatinine was elevated (> 120 μmol/L) on enrolment in 17 (28%) patients, but was normal or falling in 16 (94%) at 48 hours and declining in the other patient by 72 hours. There was no clinically meaningful increase in plasma lactate or creatinine in any patient with a normal value on enrolment. Patients receiving fluid replacement with the conservative fluid replacement algorithm were more likely to survive than historical controls in the same hospitals who had received fluid replacement guided by clinical judgement in the year prior to the study (p = 0.03), despite having more severe disease (p < 0.001).


A conservative fluid resuscitation strategy appears safe in adults hospitalised with malaria.
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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.
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