HYPONATREMIA AND DEHYDRATION IN SEVERE MALARIA

The prevalence and hyponatraemia in malaria were investigated. One hun dred and thirty two children, 47 of whom had cerebral malaria, were pr ospectively recruited and serial simple indices of fluid and electroly te balance and renal function monitored during admission. In 55%, hypo natraemia (sodium <135 mmol/l) was present on admission. Hyponatraemia was pronounced (sodium less than or equal to 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). Overa ll, 31% of survivors were at least moderately dehydrated on admission (5% weight gain by discharge). These children had higher plasma urea c oncentrations 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 admissi on and discharge in children who survived (creatinine 65.7 v 37.9 mu m ol/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 secreti on of antidiuretic hormone.