BLOOD-GLUCOSE LEVELS IN MALAWIAN CHILDREN BEFORE AND DURING THE ADMINISTRATION OF INTRAVENOUS QUININE FOR SEVERE FALCIPARUM-MALARIA
BLOOD-GLUCOSE LEVELS IN MALAWIAN CHILDREN BEFORE AND DURING THE ADMINISTRATION OF INTRAVENOUS QUININE FOR SEVERE FALCIPARUM-MALARIA
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DOI：
10.1056/nejm198810203191602
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发表时间：
1988-10-20
影响因子：
158.5
通讯作者：
MORRIS, K
中科院分区：
文献类型：
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作者：
TAYLOR, TE;MOLYNEUX, ME;MORRIS, K
患有严重的未经治疗的疟疾的患者可能会出现低血糖，并且由于奎宁诱导的高胰岛素血症，可能使胃肠外奎宁治疗过程复杂化。静脉注射奎宁越来越多地被用作严重疟疾患者的首选疗法，其中大多数是儿童。为了评估治疗前和奎宁相关的低血糖症的重要性，在该地区的疾病流行，我们前瞻性研究了95名马拉维儿童恶性疟疾和意识改变谁是静脉注射奎宁治疗。19例患者在治疗前发生低血糖。7人（37%）死亡，5名幸存者（26%）有神经系统后遗症。最初血糖正常的患者的相应值分别为4%和4%（P < 0.0001）。低血糖症与低血浆胰岛素浓度和高血浆乳酸、丙氨酸和5“-核苷酸酶浓度相关。这一发现表明，肝再生受损而不是高胰岛素血症有助于治疗前低血糖的发病机制。所有患者均接受5%葡萄糖输注的盐酸奎宁，低血糖患者接受50%葡萄糖。治疗前低血糖的患者中有7例再次发生低血糖，但这些事件也与高胰岛素血症无关。在76名最初血糖正常的儿童中，在静脉注射奎宁治疗过程中没有一名儿童出现低血糖。我们的结论是，低血糖是一种常见的并发症恶性疟疾的儿童，它反映了严重的疾病，并与预后不良。我们没有发现这是奎宁治疗的并发症。
Hypoglycemia may develop in patients with severe untreated malaria and can complicate the course of treatment with parenteral quinine as a result of quinine-induced hyperinsulinemia. Intravenous quinine is used increasingly as the therapy of choice in patients with severe malaria, most of whom are children. To assess the importance of both pretreatment and quinine-related hypoglycemia in children in an area in which the disease in endemic, we prospectively studied 95 Malawian children with falciparum malaria and altered consciousness who were treated with intravenous quinine. Nineteen patients had hypoglycemia before treatment. Seven (37 percent) died, and five of the survivors (26 percent) had neurologic sequelae. The corresponding values for patients who were initially normoglycemic were 4 percent and 4 percent, respectively (P < 0.0001). Hypoglycemia was associated with low plasma insulin concentrations and with elevated plasma concentrations of lactate, alanine, and 5''-nucleotidase.sbd. a finding that suggests that impaired hepatic gluconeogenesis but not hyperinsulinemia contributes to the pathogenesis of pretreatment hypoglycemia. All patients were given quinine dihydrochloride in a 5 percent dextrose infusion, and those with hypoglycemia received 50 percent dextrose. Hypoglycemia recurred in seven of the patients with pretreatment hypoglycemia, but these episodes were also not associated with hyperinsulinemia. Of the 76 children who were initially normoglycemic, none became hypoglycemic during the course of treatment with intravenous quinine. We conclude that hypoglycemia is a frequent complication of falciparum malaria in children and that it reflects severe disease and is associated with a poor prognosis. We did not find it to be a complication of quinine treatment.