BACKGROUND Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined. METHODS In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated. RESULTS A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8-5.1) mL/kg per hour and 2.2 (IQR, 1.6-3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; rs = 0.16; P = .089) or lactate at 6 hours (n = 94; rs = -0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration. CONCLUSIONS Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2-3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.

中文翻译：

---

成人严重恶性疟疾限制性液体管理与肾功能和组织灌注之间的关联：一项前瞻性观察研究。

背景技术已经证明，自由液体复苏对患有严重疟疾的成年人有害，但尚无限制水平。方法在一项针对成年人严重恶性疟疾的前瞻性观察研究中，由治疗医师酌情提供限制性液体管理。评估体液量与肾功能或组织灌注变化之间的关系。结果共研究了154例患者，其中41例（26.6％）死亡。入组后最初6和24个小时的总液体摄入量中位数分别为每小时3.3（四分位间距[IQR]，1.8-5.1）mL / kg和每小时2.2（IQR，1.6-3.2）mL / kg。6小时的总液体摄入量与24小时的血浆肌酐变化（n = 116; rs = 0.16; P = .089）或6小时的乳酸盐变化（n = 94; rs = -0.05; P =。660）。入选后24小时内出现低血压休克或肺水肿与输液量无关。结论成年严重恶性疟疾患者的限制性液体管理并未使肾脏功能和组织灌注恶化。我们建议在最初的24小时内以每小时2-3 mL / kg的晶体剂量进行无须推注的治疗，除非患者血压低。