According to received wisdom, it reflects congestive heart failure brought on by anaemia. Very high lactate levels appeared to be the major problem, probably due to reduced oxygen delivery, itself a consequence of anaemia and low blood volumes. Furthermore, in studies of oxygen consumption, the most seriously ill children showed dramatic increases in oxygen consumption after blood transfusion. Such results argue strongly that transfusion should be widely used in children showing signs of respiratory distress and metabolic acidosis. But lactic acidosis is not the only problem.
Similar symptoms arise from misuse of salicylates such as aspirin.
Although aspirin is no longer given to children in the West, salicylates are used extensively in Africa for treating fevers - often in massive doses. As well as the possibility of misdiagnosis, it is conceivable that salicylates might also be exacerbating the disease of malaria patients. In Kilifi 90 per cent of a group of children with severe malaria had detectable salicylates in their bloodstream, and several appeared to be suffering from chronic salicylate poisoning. Moreover, salicylate levels were closely linked both to the degree of acidosis and to falls in blood glucose levels - two of the most important complications in severe malaria. One way to tackle this problem is to involve the local community, particularly the shopkeepers who supply the aspirin.