Volume 80, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Although hyponatremia occurs in most patients with severe malaria, its pathogenesis, prognostic significance, and optimal management have not been established. Clinical and biochemical data were prospectively collected from 171 consecutive Bangladeshi adults with severe malaria. On admission, 57% of patients were hyponatremic. Plasma sodium and Glasgow Coma Score were inversely related ( = −0.36, < 0.0001). Plasma antidiuretic hormone concentrations were similar in hyponatremic and normonatremic patients (median, range: 6.1, 2.3–85.3 versus 32.7, 3.0–56.4 pmol/L; = 0.19). Mortality was lower in hyponatremic than normonatremic patients (31.6% versus 51.4%; odds ratio [95% confidence interval]: 0.44 [0.23–0.82]; = 0.01 by univariate analysis). Plasma sodium normalized with crystalloid rehydration from (median, range) 127 (123–140) mmol/L on admission to 136 (128–149) mmol/L at 24 hours ( = 0.01). Hyponatremia in adults with severe malaria is common and associated with preserved consciousness and decreased mortality. It likely reflects continued oral hypotonic fluid intake in the setting of hypovolemia and requires no therapy beyond rehydration.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Dondorp A, Nosten F, Stepniewska K, Day N, White N, 2005. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 366 : 717–725. [Google Scholar]
  2. English MC, Waruiru C, Lightowler C, Murphy SA, Kirigha G, Marsh K, 1996. Hyponatremia and dehydration in severe malaria. Arch Dis Child 74 : 201–205. [Google Scholar]
  3. Holst FG, Hemmer CJ, Kern P, Dietrich M, 1994. Inappropriate secretion of antidiuretic hormone and hyponatremia in severe falciparum malaria. Am J Trop Med Hyg 50 : 602–607. [Google Scholar]
  4. Miller LH, Makaranond P, Sitprija V, Suebsanguan C, Canfield CJ, 1967. Hyponatremia in malaria. Ann Trop Med Parasitol 61 : 265–279. [Google Scholar]
  5. Sowunmi A, 1996. Hyponatremia in severe falciparum malaria: a clinical study of nineteen comatose African children. Afr J Med Med Sci 25 : 47–52. [Google Scholar]
  6. Enwere GC, Ota MO, Obaro SK, 2000. Electrolyte derangement in cerebral malaria: a case for a more aggressive approach to the management of hyponatremia. Ann Trop Med Parasitol 94 : 541–547. [Google Scholar]
  7. World Health Organization, 2000. Severe falciparum malaria. Trans R Soc Trop Med Hyg 94 (Suppl 1): S1–S90. [Google Scholar]
  8. Sowunmi A, 1996. Renal function in acute falciparum malaria. Arch Dis Child 74 : 293–298. [Google Scholar]
  9. Planche T, Onanga M, Schwenk A, Dzeing A, Borrmann S, Faucher JF, Wright A, Bluck L, Ward L, Kombila M, Kremsner PG, Krishna S, 2004. Assessment of volume depletion in children with malaria. PLoS Med 1 : e18. [Google Scholar]
  10. Idro R, Aketch S, Gwer S, Newton CR, Maitland K, 2006. Research priorities in the management of severe Plasmodium falciparum malaria in children. Ann Trop Med Parasitol 100 : 95–108. [Google Scholar]
  11. Ellison DH, Berl T, 2007. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med 356 : 2064–2072. [Google Scholar]
  12. Palmer BF, 2003. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab 14 : 182–187. [Google Scholar]
  13. Asadollahi K, Beeching N, Gill G, 2006. Hyponatremia as a risk factor for hospital mortality. QJM 99 : 877–880. [Google Scholar]
  14. Maitland K, Pamba A, Newton CR, Levin M, 2003. Response to volume resuscitation in children with severe malaria. Pediatr Crit Care Med 4 : 426–431. [Google Scholar]
  15. Tran TH, Day NP, Nguyen HP, Nguyen TH, Tran TH, Pham PL, Dinh XS, Ly VC, Ha V, Waller D, Peto TE, White NJ, 1996. A controlled trial of artemether or quinine in Vietnamese adults with severe falciparum malaria. N Engl J Med 335 : 76–83. [Google Scholar]
  16. World Health Organization, 2000. Management of Severe Falciparum Malaria. A Practical Handbook. Available at: http://www.who.int/malaria/docs/hbsm.pdf. Accessed June 2008.
  17. Cockcroft DW, Gault MH, 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16 : 31–41. [Google Scholar]
  18. Stevens LA, Coresh J, Greene T, Levey AS, 2006. Assessing kidney function–measured and estimated glomerular filtration rate. N Engl J Med 354 : 2473–2483. [Google Scholar]
  19. Dunn FL, Brennan TJ, Nelson AE, Robertson GL, 1973. The role of blood osmolality and volume in regulating vasopressin secretion in the rat. J Clin Invest 52 : 3212–3219. [Google Scholar]
  20. Baylis PH, 1987. Osmoregulation and control of vasopressin secretion in healthy humans. Am J Physiol 253 : R671–R678. [Google Scholar]
  21. Day NP, Phu NH, Mai NT, Chau TT, Loc PP, Chuong LV, Sinh DX, Holloway P, Hien TT, White NJ, 2000. The pathophysiologic and prognostic significance of acidosis in severe adult malaria. Crit Care Med 28 : 1833–1840. [Google Scholar]
  22. Mishra SK, Panigrahi P, Mishra R, Mohanty S, 2007. Prediction of outcome in adults with severe falciparum malaria: a new scoring system. Malar J 6 : 24. [Google Scholar]
  23. Singh S, Bohn D, Carlotti AP, Cusimano M, Rutka JT, Halperin ML, 2002. Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit Care Med 30 : 2575–2579. [Google Scholar]
  24. Patterson MJ, Galloway SD, Nimmo MA, 2000. Variations in regional sweat composition in normal human males. Exp Physiol 85 : 869–875. [Google Scholar]
  25. Field M, 1977. New strategies for treating watery diarrhea. N Engl J Med 297 : 1121–1122. [Google Scholar]
  26. Sitprija V, Napathorn S, Laorpatanaskul S, Suithichaiyakul T, Moollaor P, Suwangool P, Sridama V, Thamaree S, Tankeyoon M, 1996. Renal and systemic hemodynamics, in falciparum malaria. Am J Nephrol 16 : 513–519. [Google Scholar]
  27. Fryatt RJ, Teng JD, Harries AD, Moody AH, Hall AP, Forsling ML, 1989. Plasma and urine electrolyte concentrations and vasopressin levels in patients admitted to hospital for falciparum malaria. Trop Geogr Med 41 : 57–60. [Google Scholar]
  28. Sowunmi A, Newton CR, Waruiru C, Lightman S, Dunger DB, 2000. Arginine vasopressin secretion in Kenyan children with severe malaria. J Trop Pediatr 46 : 195–199. [Google Scholar]
  29. Ustianowski A, Schwab U, Pasvol G, 2002. Case report: severe acute symptomatic hyponatremia in falciparum malaria. Trans R Soc Trop Med Hyg 96 : 647–648. [Google Scholar]

Data & Media loading...

  • Received : 05 Aug 2008
  • Accepted : 25 Sep 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error