Haruhiko IshiokaKatherine PlewesRajyabardhan PattnaikHugh W.F. KingstonStije J. LeopoldM. Trent HerdmanKishore MahantaAnita MohantyChandan DeyShamsul AlamKetsanee SrinamonAkshaya MohantyRichard J. MaudeNicholas J. WhiteNicholas P.J. DayMd Amir HossainMd Abul FaizPrakaykaew CharunwatthanaSanjib MohantyAniruddha GhoseArjen M. DondorpJichi Medical UniversityIspat General HospitalHarvard T.H. Chan School of Public HealthInstitute of Life Sciences IndiaMahidol UniversityNuffield Department of Clinical MedicineChittagong Medical CollegeDev Care Foundation2020-01-272020-01-272020-01-02The Journal of infectious diseases. Vol.221, No.2 (2020), 285-292153766132-s2.0-85077349343https://repository.li.mahidol.ac.th/handle/123456789/49642© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. 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.Mahidol UniversityMedicineArticleSCOPUS10.1093/infdis/jiz449