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Hyponatraemia and dehydration in severe malaria
M C English1, C Waruiru, C Lightowler
1Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
Insights
Hyponatremia is common in severe childhood malaria, affecting over half of patients. Children with hyponatremia were less dehydrated, suggesting appropriate antidiuretic hormone secretion, unlike those with normal sodium levels.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Severe childhood malaria presents complex fluid and electrolyte challenges.
- Hyponatremia is a frequently observed complication in pediatric malaria cases.
Purpose of the Study:
- To investigate the prevalence and underlying causes of hyponatremia in severe childhood malaria.
- To assess the relationship between hyponatremia, dehydration, and renal function in these patients.
Main Methods:
- Prospective recruitment of 132 children with severe malaria, including 47 with cerebral malaria.
- Serial monitoring of fluid balance, electrolytes, and renal function indices during hospitalization.
Main Results:
- Hyponatremia (sodium < 135 mmol/l) was present in 55% of children on admission.
- Hyponatremic children exhibited less weight gain and were less dehydrated compared to those with normal sodium levels.
- Dehydration was common (31% of survivors) and associated with higher urea and more acidosis on admission, with improved renal function markers at discharge.
Conclusions:
- Dehydration is a significant issue in severe childhood malaria, potentially impairing renal function.
- Hyponatremia in this context may indicate appropriate antidiuretic hormone secretion and less water depletion.
Abstract:
The prevalence and likely cause of hyponatraemia in severe childhood malaria were investigated. One hundred and thirty two children, 47 of whom had cerebral malaria, were prospectively recruited and serial simple indices of fluid and electrolyte balance and renal function monitored during admission. In 55%, hyponatraemia (sodium < 135 mmol/l) was present on admission. Hyponatraemia was pronounced (sodium < or = 130 mmol/l) in 21%, and these children gained less weight during admission (mean weight gain 2.4% v 4.3%) than children with a normal sodium (135-145 mmol/l). Overall, 31% of survivors were at least moderately dehydrated on admission (5% weight gain by discharge). These children had higher plasma urea concentrations on admission (6.1 v 4.5 mmol/l) and were more acidotic (mean base excess -12.1 v -8.0) than children who were not dehydrated. There were changes in simple indices of renal function between admission and discharge in children who survived (creatinine 65.7 v 37.9 mumol/l and urea 5.5 v 1.9 mmol/l). The results suggest that dehydration is common in severe childhood malaria, that it may contribute to mild impairment in renal function, and that hyponatraemic children are less water depleted, showing appropriate rather than inappropriate secretion of antidiuretic hormone.