Blood glucose homeostasis in severe plasmodium falciparum malaria in Tanzanian children seen at Muhimbili Medical Centre

Hypoglycemia has been frequently reported as a complication of severe plasmodium falciparum malaria. To determine if the disruption in blood glucose homeostasis is also present in other very sick children without malaria, we have compared the glycaemic status, gluconeogenic and ketogenie substrates, insulin and C-peptides on admission and during treatment in these two groups of children. The effect of quinine on these parameters in those with malaria was also studied. 97 infants and children with severe P.falciparum malaria (36 in coma due to cerebral malaria and 61 with otherforms of severe and complicated malaria) and 89 with other serious illnesses (32 in coma 57 with severe pneumonia and not in coma) were studied. Hypoglycemia wasfound in 4(10.8%) of the patients with cerebral malaria and in 1(1.6%) of the patients with other forms of severe and complicated malaria, in 7(21.8%) of the patients in coma due to causes other than malaria and in 3(5%) of the patients with other illnesses but not in coma. There was no significant difference in the occurrence of hypoglycemia in the 2 groups of comatose children (P=0.0564) and there was no correlation between malaria parasite counts and the blood glucose levels. Compared with normogiycemic patients, hypoglycemic patients had, appropriately low serum insulin levels (3.0 vs 8.2 IU/L, P=0.004) and serum alanine (340 vs 150, not significantly different), a profile suggestive of impaired hepatic gluconeogenesis. Quinine therapy did not produce hypoglycemia or hyperinsulinaemia in the children with malaria. Hypoglycemia, the level of consciousness and death were all significantly associated with the duration since the last meal. Of the 15 hypoglycemic patients, 10(67%) died. From these results, it appears that derangement in blood glucose homeostasis in very sick children is a metabolic disorder associated with a poor prognosis but is not specific for malaria. It should be looked for in all severely sick children and bolus glucose may not be enough to correct it.