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Acid-base status in paediatric Plasmodium falciparum malaria
T E Taylor1, A Borgstein, M E Molyneux
1Queen Elizabeth Central Hospital, Blantyre, Malawi.
The Quarterly Journal of Medicine
|February 1, 1993
Summary
Acidaemia (abnormal acidity) is common in severe childhood falciparum malaria and strongly predicts mortality. While quickly corrected by standard treatments, its independent prognostic value warrants further investigation for targeted interventions.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Biochemistry
- Malariology
Background:
- Falciparum malaria is a leading cause of childhood mortality in endemic regions.
- Acid-base disturbances, particularly acidaemia, are frequently observed in severe malaria.
- The prognostic significance of acidaemia in pediatric malaria requires further elucidation.
Purpose of the Study:
- To determine the prognostic significance of acidaemia in children with severe falciparum malaria.
- To assess the rate of resolution of acidaemia in these patients.
- To investigate the relationship between acidaemia and other clinical parameters.
Main Methods:
- Prospective study of 141 Malawian children admitted with falciparum malaria.
- Measurement of acid-base status (capillary blood pH) in patients with uncomplicated and severe (cerebral) malaria.
- Analysis of mortality rates and clinical predictors in relation to acidaemia.
Main Results:
- Acidaemia (pH < 7.3) was significantly more prevalent in cerebral malaria (42%) than uncomplicated malaria (5%).
- Acidaemia was strongly associated with increased mortality, independent of other known risk factors.
- Acidaemic patients exhibited slower respiratory rates and abnormal respiratory rhythms, suggesting impaired compensation for metabolic acidosis.
Conclusions:
- Acidaemia is a significant independent predictor of mortality in children with severe falciparum malaria.
- While acidaemia resolves with standard fluid and antimalarial therapy, its independent prognostic role highlights the need for evaluating specific interventions.
- Further research is needed to explore targeted therapies for acidaemia in severe pediatric malaria.