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Specificity of hypoglycaemia for cerebral malaria in children
N G Kawo1, A E Msengi, A B Swai
1Department of Paediatrics, Muhimbili Medical Centre, University of Dar es Salaam, Tanzania.
Insights
Hypoglycaemia (low blood glucose) is not specific to severe malaria in children. It occurs in severely ill, fasted children due to glycogen depletion and should be monitored in all sick children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Biochemistry
- Critical Care Medicine
Background:
- Hypoglycaemia is a known complication of severe falciparum malaria in children.
- The specific contribution of malaria to hypoglycaemia versus general critical illness in children is not fully elucidated.
Purpose of the Study:
- To compare the frequency of hypoglycaemia in children with severe falciparum malaria versus other serious illnesses.
- To investigate the metabolic profile and clinical associations of hypoglycaemia in these pediatric populations.
Main Methods:
- A comparative study involving 97 children with severe falciparum malaria and 89 children with other serious illnesses.
- Measurement of blood glucose, serum insulin, C-peptide, and plasma non-esterified fatty acids.
- Analysis of associations between hypoglycaemia, clinical status (consciousness, death), and time since last meal.
Main Results:
- The frequency of hypoglycaemia (blood glucose < 2.2 mmol/l) did not significantly differ between malarial (5.2%) and control (11.2%) groups.
- Hypoglycaemic patients exhibited low insulin and C-peptide levels with elevated non-esterified fatty acids.
- Hypoglycaemia, consciousness level, and mortality were all associated with the time since the last meal.
Conclusions:
- Hypoglycaemia is not a malaria-specific complication but is associated with severe illness and fasting in children.
- It results from glycogen depletion and potentially impaired hepatic gluconeogenesis.
- Hypoglycaemia should be screened for in all severely ill children, and a single glucose dose may be insufficient for correction.
Abstract:
Glycaemic status on hospital admission was compared in 97 children with severe falciparum malaria (36 with cerebral malaria) and 89 children with other serious illnesses (32 in coma; 57 with acute pneumonia, not in coma). The frequency of hypoglycaemia (blood glucose below 2.2 mmol/l) did not differ significantly between malarial and control patients (5.2% vs 11.2%) nor between the comatose (11.1% vs 18.8%) and conscious (1.6% vs 7.0%) malarial and control subgroups. Compared with normoglycaemic patients, hypoglycaemic patients had appropriately low serum insulin (3.0 vs 8.2 mU/l) and C-peptide (0.13 vs 0.42 mmol/l) and high plasma non-esterified fatty acids (1.42 vs 0.83 mmol/l). Hypoglycaemia, the level of consciousness, and death were all significantly associated with the time since the last meal. Hypoglycaemia is not a specific complication of malaria but is found in severely ill fasted children, resulting from glycogen depletion and perhaps impaired hepatic gluconeogenesis. It should be sought in all severely sick children. A single bolus dose of glucose may not be enough to correct it.