Acid-base status in paediatric Plasmodium falciparum malaria

Abstract

We measured the acid-base status of children with falciparum malaria in order to determine the prognostic significance and rate of resolution of acidaemia in patients with severe disease. We prospectively studied 141 Malawian children who were admitted to Hospital, with falciparum malaria, 60 of whom had cerebral malaria (unrousable coma, unable to localize a painful stimulus). Of the 60 patients with cerebral malaria 25 (42%) were acidaemic (capillary blood pH < 7.3); of 81 children with uncomplicated malaria 4 (5%) were acidaemic (p < 0.0001). Eleven patients died; of these, eight presented with cerebral malaria, eight with acidaemia and seven with both. The strong association of altered acid-base status with disease severity and mortality was independent of other previously identified predictors of illness and death in malaria. Acidaemia was not associated with shock, bacteraemia or hypoxaemia. Acidaemic patients had a slower mean respiratory rate and a higher incidence of respiratory rhythm abnormalities than other patients, suggesting that acidaemia is in part the result of inadequate respiratory compensation for metabolic acidosis. Although acidaemia is quickly corrected by fluids and antimalarial drugs, specific therapy to correct acidaemia needs evaluation in children with severe malaria.