On the nature of orthostatic hypotension in acute malaria *

Abstract

From an experience with a large number of patients with acute malaria in Vietnam, the authors conclude that orthostatic hypotension is a prominent clinical feature of this disorder. In 13 such patients pulse and blood pressures were measured in the recumbent and standing positions. The degree of dehydration of these patients was also assessed by serum osmolality, specific gravity, sodium concentration and other studies. Postural hypotension was again assessed following rehydration of the patients prior to institution of antimalarial therapy, Rehydration produced only a small and rather insignificant improvement in the postural hypotension. It was concluded that the principal mechanism of orthostatic hypotension in acute malaria was a combination of relative bradycardia, which persisted in the upright state, and redistribution of blood volume to the skin by peripheral vasodilatation.