Sublingual sugar administration as an alternative to intravenous dextrose administration to correct hypoglycemia among children in the tropics
Sublingual sugar administration as an alternative to intravenous dextrose administration to correct hypoglycemia among children in the tropics
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DOI：
10.1542/peds.2004-2218
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发表时间：
2005-11-01
期刊：
影响因子：
8
通讯作者：
Pussard, E
中科院分区：
文献类型：
--
作者：
Barennes, H;Valea, I;Pussard, E
背景。低血糖是撒哈拉以南非洲地区严重疟疾患儿预后不良的常见决定因素。静脉给药葡萄糖很少可用。口腔粘膜给药可以替代肠外给药。在布基纳法索对中度低血糖儿童进行了一项随机临床试验，比较舌下糖给药与口服水、口服糖和葡萄糖输注给药。69名血糖浓度< 0.8 g/L的儿童随机分为4种给药方式，1种给药方式中有3种不同剂量的糖，分别为：口服组（OG） （n = 15）：糖2.5 g；舌下组（SG = 27）：舌下糖2.5 g，分0.1 g/kg、0.15 g/kg、0.2 g/kg 3个治疗亚组；静脉注射组（IG） （n = 8）：单次给药30%葡萄糖8 mL；水组（n = 11）。8名儿童接受两次舌下糖治疗，即在基线和20分钟后分别给予0.1 g/kg。每20分钟测量一次血糖浓度，持续80分钟。评估治疗失败、血糖浓度峰值、葡萄糖浓度正常化所需时间和动力学剖面。SG组和IG组均无治疗失败，而OG组和水组分别有8例（53%）和9例（81.8%）失败。SG儿童的葡萄糖动力学特征和生物利用度（3个SG组分别为77%、99%和81%）与IG儿童相似。SG和OG的生物利用度分别为84%和38%。7岁以下的儿童需要反复舌下给药以维持正常血糖。舌下给糖被证明对中度低血糖儿童有效。无论是在发展中国家还是在发达国家，这都是控制儿童低血糖的一种简单而有前途的方法。应在患有严重疟疾的儿童中更详细地调查这种儿科做法。
Background. Hypoglycemia is a common determining factor of poor prognosis for children with severe malaria in sub-Saharan Africa. Intravenous dextrose administration is rarely available. Oral mucosal delivery may be an alternative to parenteral administration. A randomized, clinical trial was performed in Burkina Faso among moderately hypoglycemic children, comparing sublingual sugar administration with oral water, oral sugar, and dextrose infusion administrations.Methods. Sixty-nine children with glucose concentrations of < 0.8 g/L were assigned randomly to 1 of 4 methods of administration, 1 with 3 different doses of sugar, as follows: oral group (OG) (n = 15): 2.5 g of sugar; sublingual group (SG) (n = 27): 2.5 g of sugar under the tongue, with 3 treatment subgroups, ie, 0.1 g/kg, 0.15 g/kg, and 0.2 g/kg; intravenous group (IG) (n = 8): 8 mL of 30% dextrose in a single bolus; water group (n = 11). Eight children received sublingual sugar twice, ie, 0.1 g/kg at baseline and 20 minutes later. Blood glucose concentrations were measured every 20 minutes for 80 minutes. Treatment failures, peak glucose concentrations, times to glucose concentration normalization, and kinetic profiles were evaluated.Results. No treatment failures were observed in the SG and IG, compared with 8 (53%) and 9 (81.8%) failures in the OG and water group, respectively. SG children exhibited glucose kinetic profiles and bioavailabilities (77%, 99%, and 81% in the 3 SG groups) similar to those of IG children. Bioavailabilities were 84% and 38% in the SG and OG, respectively. Children > 7 years of age required repeated sublingual administrations to maintain normoglycemia.Conclusions. The sublingual administration of sugar proved to be effective among moderately hypoglycemic children. It is a simple and promising method to control hypoglycemia among children in both developing and developed countries. This pediatric practice should be investigated in more detail among children with severe malaria.