Hyponatraemia In Cerebral Malaria And Association With Outcome

Abstract

Cerebral malaria is a severe and potentially fatal neurological manifestation of malaria. Hyponatremia is observed in the majority of adult and pediatric patients with severe malaria. The importance of correcting the hyponatremia that complicates severe malaria is debated. A total of 60 cases of Cerebral Malaria studied in the Department of Paediatrics, Bal Chikitsalaya, MB Hospital, RNT Medical College, Udaipur, Rajasthan in between March 2015 to February 2016 for a period of one year. Total 40 (66.7%) was positive for P. falciparum , 11 (18.3%) for P. vivax and 9 (15%) for both P. falciparum and P. vivax. Total 44 (73.3%) patients were hyponatremic ( 135 Meq/L), 28 (46.7%) had sodium level 130 Meq/L and 2 (3.3%) patients had very low sodium ( 120 Meq/L). Total 30 patients of P.falciparum positive had low sodium ( 135 Meq/L). All patients had GCS 11 and out of them maximum patients i.e. 42 (70%) belonged to low sodium group (121-134 Meq/L). 23 (38.3%) patients had deep coma (GCS ? 7) and out of them 13 (21.6%) were from low sodium group (121-134 Meq/L). Mortality was 7 (11.7%) and 6 were from low sodium group ( 135 Meq/L). In conclusion, this study showed that hyponatremia is a common feature in children presenting with Cerebral Malaria and it is associated with increased mortality. There is direct relationship between serum sodium and GCS. Thus, early detection, prompt management and adequate supportive therapy are key steps to reduce morbidity and mortality due to Cerebral Malaria.