Are the children with rapid breathing in heart failure or at risk of heart failure?
Detailed physiological studies of critically sick children with respiratory distress have show that the features of metabolic acidosis and volume depletion were common is these children. Conversely, confirmatory physiological evidence to suggest heart failure was rarely reported. In the safety and efficacy fluid resuscitation studies we conducted we anticipated that the intervention may have the potential to cause pulmonary oedema (heart failure) as a life threatening complication, especially in children with evidence of mild-moderate malnutrition. We have now reported data from four separate trials including 301 closely monitored children with severe malarial acidosis receiving volume expansion, including children with severe symptomatic malarial anaemia (haemoglobin <5g/dl) and 20-30% had anthropometric indices of moderate malnutrition. Clinical features of pulmonary oedema only developed in two cases – an overall complication rate ~0.7%. Diuretics were neither prescribed routinely n
