Hypoglycaemia in severe malaria, clinical associations and relationship to quinine dosage

BMC Infectious Diseases

Research Article

Mwanamvua Boga¹  Esther Kivaya¹  Samuel Akech¹  Gilbert N Ogetii¹  Julie Jemutai¹  Greg Fegan²  Kathryn Maitland³ 

[1] Centre for Geographic Medicine Research, Kenya Medical Research Institute- Wellcome Trust Programme, PO Box 230, Kilifi, Kenya;Centre for Geographic Medicine Research, Kenya Medical Research Institute- Wellcome Trust Programme, PO Box 230, Kilifi, Kenya;Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;Centre for Geographic Medicine Research, Kenya Medical Research Institute- Wellcome Trust Programme, PO Box 230, Kilifi, Kenya;Department of Paediatrics and Wellcome Trust Centre for Clinical Tropical Medicine, Faculty of Medicine, Imperial College, Norfolk Place, W2 1PG, London, UK;

关键词: Malaria;    Quinine;    Severe Malaria;    Artesunate;    Hypoglycaemia Episode;   

DOI  :  10.1186/1471-2334-10-334

 received in 2010-07-30, accepted in 2010-11-22,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundHypoglycaemia is an independent risk factor for death in severe malaria and a recognized adverse treatment effect of parenteral quinine. In 2006 our hospital changed quinine treatment policy from 15 mg/kg loading (plus 10 mg/kg 12-hourly) to 20 mg/kg loading (plus 10 mg/kg 8-hourly) to comply with new WHO guidelines. This presented us with the opportunity to examine whether there was any dose relationship of quinine and hypoglycaemia occurrence.MethodsRetrospective case notes review of all children admitted to hospital with severe falciparum malaria between April 2002 - July 2009, before and after the introduction of the new WHO quinine regimen. Four-hourly bedside glucose levels were measured until intravenous quinine was discontinued. Clinical events immediately preceding or concurrent with each episode of hypoglycaemia (glucose < = 3.0 mmol/l) were recorded.Results954 children received the old quinine regime and 283 received the new regime. We found no evidence of an increased prevalence of hypoglycaemia (< = 3.0 mmol/L) on the new regime compared to former (15% vs. 15%); similar findings were noted for profound hypoglycaemia (< 2.2 mmols/L) 8% v 5%, P = 0.07. Episodes were co-incident with disease severity markers: coma (57%), circulatory failure (38%) and respiratory distress (21%) but less commonly with seizures (10%). Disruption of maintenance fluids and/or blood transfusion concurred with 42% of the hypoglycaemia episodes. Post admission hypoglycaemia increased odds of fatal outcome (24%) compared to euglycaemic counterparts (8%), odds ratio = 3.45 (95% confidence interval = 2.30-5.16) P < 0.01.ConclusionThere was no evidence to indicate a dose relationship between quinine and occurrence of hypoglycaemia. Hypoglycaemia concurred with severity features, disruption of glucose infusion and transfusion. Careful glucose monitoring should be targeted to these complications where resources are limited.

【 授权许可】

Unknown   
© Ogetii et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.