***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Children with severe malnutrition who develop shock have a high  mortality . Contrary to contemporaneous paediatric practice , current guidelines recommend use of low dose hypotonic fluid resuscitation ( half-strength Darrows/5 % dextrose ( HSD/5D ) . We evaluated the safety and efficacy of this guideline compared to resuscitation with a st and ard isotonic solution . Methods A Phase II r and omised controlled , safety and efficacy trial in Kenyan children aged over 6 months with severe malnutrition and shock including children with severe dehydration/shock and presumptive septic shock ( non-diarrhoeal shock ) . Eligible children were r and omised to HSD/5D or Ringer 's Lactate ( RL ) . A maximum of two boluses of 15 ml/kg of HSD/5D were given over two hours ( as recommended by guidelines ) while those r and omised to RL received 10 ml/kg aliquots half hourly ( maximum 40 ml/kg ) . Primary endpoint was resolution of shock at 8 and 24 hours . Secondary outcomes included resolution of acidosis , adverse events and mortality . Results 61 children were enrolled : 41 had shock and severe dehydrating diarrhoea , 20 had presumptive septic shock ; 69 % had decompensated shock . By 8 hours response to volume resuscitation was poor with shock persisting in most children:-HSD/5D 15/22 ( 68 % ) and RL14/25 ( 52 % ) , p = 0.39 . Oliguria was more prevalent at 8 hours in the HSD/5D group , 9/22 ( 41 % ) , compared to RL-3/25 ( 12 % ) , p = 0.02 . Mortality was high , HSD/5D-15/26(58 % ) and RL 13/29(45 % ) ; p = 0.42 . Most deaths occurred within 48 hours of admission . Neither pulmonary oedema nor cardiogenic failure was detected . Conclusions Outcome was universally poor characterised by persistence of shock , oliguria and high case fatality . Isotonic fluid was associated with modest improvement in shock and survival when compared to HSD/5D but inconclusive due to the limitations of design and effectiveness of either resuscitation strategy . Although isotonic fluid resuscitation did not result in cardiogenic heart failure , as previously feared , we conclude that the modest volumes used and rate of infusion were insufficient to promptly correct shock . The adverse performance of the recommended fluid resuscitation guideline for severe malnutrition should prompt clinical investigation of isotonic fluids for resuscitation of compensated shock , defining rate and volumes required to inform future guidelines .Trial Registration The trial is registered as ISCRTN : Introduction Inadequate initial treatment and delayed hemodynamic stabilization ( HDS ) may be associated with increased risk of death in severe sepsis patients . Methods In order to compare the hemodynamic efficacy and safety of 6 % HES 130/0.4 and NaCl 0.9 % for HDS in patients with severe sepsis , we design ed a prospect i ve , multicenter , active-controlled , double-blind , r and omized study in intensive care units . Results 174 out of 196 patients reached HDS ( 88 and 86 patients for HES and NaCl , respectively ) . Significantly less HES was used to reach HDS vs. NaCl ( 1,379 ±886 ml in the HES group and 1,709 ±1,164 ml in the NaCl group ( mean difference = -331± 1,033 , 95 % CI -640 to -21 , P = 0.0185 ) . Time to reach HDS was 11.8 10.1 hours vs. 14.3 ±11.1 hours for HES and NaCl , respectively . Total quantity of study drug infused over four consecutive days , ICU and hospital LOS , and area under the curve of SOFA score were comparable . Acute renal failure occurred in 24 ( 24.5 % ) and 19 ( 20 % ) patients for HES and NaCl , respectively ( P = 0.454 ) . There was no difference between AKIN and RIFLE criteria among groups and no difference in mortality , coagulation , or pruritus up to 90 days after treatment initiation . Conclusion Significantly less volume was required to achieve HDS for HES vs. NaCl in the initial phase of fluid resuscitation in severe sepsis patients without any difference for adverse events in both groups . Clinical Trials.gov Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Symptomatic severe malarial anaemia ( SMA ) has a high fatality rate of 30–40 % ; most deaths occur in children awaiting blood transfusion . Blood transfusion services in most of Africa are not capable of delivering adequate supplies of safe blood in a timely manner to critically ill children with SMA . Contrary to widely held belief , hypovolaemia , rather than heart failure , has emerged as a common complication in such children . We examined the safety of  pre‐transfusion management ( PTM )  by volume expansion , aim ed at stabilizing children and obviating the urgency for blood transfusion . Kenyan children with severe falciparum anaemia ( haemoglobin < 5 g/dl ) and respiratory distress were r and omly assigned to 20 ml/kg of 4·5 % albumin or 0·9 % saline or maintenance only ( control ) while awaiting blood transfusion . PTM was apparently safe since it did not lead to the development of pulmonary oedema or other adverse events . There was no significant difference in the primary outcome [ mean percentage reduction in base excess between admission and 8 h ( 95 % confidence interval ) ] between the control group 42 % ( 19–66 % ) albumin group 44 % ( 32–57 % ) and saline group 36 % ( 16–57 % ) ; adjusted analysis of variance F = 0·31 , P = 0·7 . However , the number of children requiring emergency interventions was significantly greater in the control group , four of 18 ( 22 % ) than the saline group 0 of 20 ( P = 0·03 ) . We have established the safety of this PTM in children with SMA whilst awaiting blood transfusion at a hospital with an adequate blood‐banking program . The impact on mortality should be assessed where blood transfusion services are unable to supply emergency transfusions BACKGROUND The role of fluid resuscitation in the treatment of children with shock and life-threatening infections who live in re source -limited setting s is not established . METHODS We r and omly assigned children with severe febrile illness and impaired perfusion to receive boluses of 20 to 40 ml of 5 % albumin solution ( albumin-bolus group ) or 0.9 % saline solution ( saline-bolus group ) per kilogram  of  body weight or no bolus ( control group ) at the time of admission to a hospital in Ug and a , Kenya , or Tanzania ( stratum A ) ; children with severe hypotension were r and omly assigned to one of the bolus groups only ( stratum B ) . All children received appropriate antimicrobial treatment , intravenous maintenance fluids , and supportive care , according to guidelines . Children with malnutrition or gastroenteritis were excluded . The primary end point was 48-hour mortality ; secondary end points included pulmonary edema , increased intracranial pressure , and mortality or neurologic sequelae at 4 weeks . RESULTS The data and safety monitoring committee recommended halting recruitment after 3141 of the projected 3600 children in stratum A were enrolled . Malaria status ( 57 % overall ) and clinical severity were similar across groups . The 48-hour mortality was 10.6 % ( 111 of 1050 children ) , 10.5 % ( 110 of 1047 children ) , and 7.3 % ( 76 of 1044 children ) in the albumin-bolus , saline-bolus , and control groups , respectively ( relative risk for saline bolus vs. control , 1.44 ; 95 % confidence interval [ CI ] , 1.09 to 1.90 ; P=0.01 ; relative risk for albumin bolus vs. saline bolus , 1.01 ; 95 % CI , 0.78 to 1.29 ; P=0.96 ; and relative risk for any bolus vs. control , 1.45 ; 95 % CI , 1.13 to 1.86 ; P=0.003 ) . The 4-week mortality was 12.2 % , 12.0 % , and 8.7 % in the three groups , respectively ( P=0.004 for the comparison of bolus with control ) . Neurologic sequelae occurred in 2.2 % , 1.9 % , and 2.0 % of the children in the respective groups ( P=0.92 ) , and pulmonary edema or increased intracranial pressure occurred in 2.6 % , 2.2 % , and 1.7 % ( P=0.17 ) , respectively . In stratum B , 69 % of the children ( 9 of 13 ) in the albumin-bolus group and 56 % ( 9 of 16 ) in the saline-bolus group died ( P=0.45 ) . The results were consistent across centers and across subgroups according to the severity of shock and status with respect to malaria , coma , sepsis , acidosis , and severe anemia . CONCLUSIONS Fluid boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion in these re source -limited setting s in Africa . ( Funded by the Medical Research Council , United Kingdom ; FEAST Current Controlled Trials number , IS RCT N69856593 . ) BACKGROUND Metabolic acidosis is the best predictor of death in children with severe falciparum malaria ; however , its treatment presents a therapeutic dilemma , because acidosis and hypovolemia may coexist with coma , which can be associated with elevated intracranial pressure . We postulated that volume resuscitation with albumin might correct acidosis and hypovolemia with a lower risk of precipitating cerebral edema than crystalloid . In an open-label , r and omized , controlled trial , we compared the safety of resuscitation with albumin to saline in Kenyan children with severe malaria . METHODS We r and omly assigned children with severe malaria and metabolic acidosis ( base deficit , > 8 mmol/L ) to receive fluid resuscitation with either 4.5 % albumin or normal saline . A control ( maintenance only ) group was only included for patients with a base deficit of < 15 mmol/L. The primary outcome measure was the percentage reduction in base deficit at 8 h. Secondary end points included death , the requirement for rescue therapies , and neurological sequelae in survivors . RESULTS Of 150 children recruited for the trial , 61 received saline , 56 received albumin , and 33 served as control subjects . There was no significant difference in the resolution of acidosis between the groups ; however , the mortality rate was significantly lower among patients who received albumin ( 3.6 % [ 2 of 56 patients ] ) than among those who received saline ( 18 % [ 11 of 61 ] ; relative risk , 5.5 ; 95 % confidence interval , 1.2 - 24.8 ; P=.013 ) . CONCLUSIONS In high-risk children with severe malaria and acidosis , fluid resuscitation with albumin may reduce mortality . Our study design did not enable us to determine whether saline administration is preferable to fluid restriction or whether saline administration is actually hazardous . Further studies are needed to confirm our findings before definitive treatment recommendations can be made Dengue hemorrhagic fever and dengue shock syndrome ( DSS ) are major causes of childhood morbidity and mortality in many tropical countries . Increased intravascular permeability leading to shock is the cardinal feature of DSS . Fluid resuscitation to counteract massive plasma leakage is the mainstay of treatment . A double-blind , r and omized trial comparing four intravenous-fluid regimens for acute resuscitation of 50 children with DSS was conducted . Colloids ( dextran 70 or the protein digest gelafundin 35,000 ) restored cardiac index and blood pressure and normalized hematocrit more rapidly than crystalloids ( Ringer 's lactate or 0.9%-weight/volume saline ) . Dextran 70 provided the most rapid normalization of the hematocrit and restoration of the cardiac index , without adverse effects , and may be the preferred solution for acute resuscitation in DSS . Further large-scale double-blind trials are required to provide an evidence -based approach to the management of DSS Objectives : A previous meta- analysis has shown a consistent survival benefit in children with severe malaria receiving human albumin solution  compared to other resuscitation fluids . Human albumin solution is expensive and not readily available in Africa . We examined the safety and efficacy of the fluid resuscitation with two synthetic colloids , Dextran 70 and hydroxyethyl starch , to inform future trial design . Design : An open-label r and omized , controlled , phase II safety and efficacy trial . Setting : High-dependency unit , Kilifi District Hospital , Kenya . Patients : Children aged > 6 months with severe falciparum malaria and acidosis ( base deficit > 8 mmol ) . Interventions : Boluses 
    Output:
    
CONCLUSIONS The studies analyzed did not find evidence to suggest that the use of colloids is superior to crystalloids .
Crystalloids are the preferred therapeutic option because of their effectiveness , low cost , and wide availability .
Colloids may be the first choice in cases of malaria when the central nervous system is affected