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Serial clinical and metabolic changes were monitored in 115 Gambian children (1.5-12 years old) with severe malaria. Fifty-three children (46%) had cerebral malaria (coma score < or = 2) and 21 (18%) died. Admission geometric mean venous blood lactate concentrations were almost twice as high in fatal cases as in survivors (7.1 mmol/L vs. 3.6 mmol/L; P < 0.001) and were correlated with levels of tumour necrosis factor (r = 0.42, n = 79; P < 0.0001) and interleukin 1-alpha (r = 0.6, n = 34; P < 0.0001). Admission blood venous glucose concentrations were lower in fatal cases than survivors (3.2 mmol/L, vs. 5.8 mmol/L; P < 0.0001). Treatment with quinine was associated with significantly more episodes of post-admission hypoglycaemia when compared with artemether or chloroquine. After treatment, lactate concentrations fell rapidly in survivors but fell only slightly, or rose, in fatal cases. Plasma cytokine levels fluctuated widely after admission. Sustained hyperlactataemia (raised lactate concentrations, 4 h after admission) proved to be the best overall prognostic indicator of outcome in this series. Lactic acidosis is an important cause of death in severe malaria.

Original publication

DOI

10.1016/0035-9203(94)90504-5

Type

Journal article

Journal

Transactions of the Royal Society of Tropical Medicine and Hygiene

Publication Date

01/1994

Volume

88

Pages

67 - 73

Addresses

Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

Keywords

Humans, Malaria, Falciparum, Seizures, Acidosis, Lactic, Hypoglycemia, Quinine, Tumor Necrosis Factor-alpha, Interleukin-1, Prognosis, Regression Analysis, Prospective Studies, Child, Child, Preschool, Infant