Related Experiment Videos
Hypoglycaemia in African children with severe malaria
Insights
Hypoglycaemia, a dangerous complication of severe falciparum malaria in African children, is treatable and not caused by antimalarial drugs. This study found low insulin and high ketones, indicating impaired liver glucose production.
Area of Science:
- Tropical Medicine
- Pediatrics
- Infectious Diseases
Background:
- Severe falciparum malaria is a significant cause of mortality in African children.
- Hypoglycaemia is a recognized complication of malaria, but its mechanisms in children are not fully understood.
- Previous studies in adults treated with quinine suggested hyperinsulinaemia as a cause of malaria-associated hypoglycaemia.
Observation:
- This prospective study investigated hypoglycaemia in 47 Gambian children with severe chloroquine-sensitive falciparum malaria.
- Fifteen children (32%) developed hypoglycaemia (plasma glucose < 2.2 mmol/l).
- Hypoglycaemic children had a significantly higher mortality rate (5/15) compared to normoglycaemic children (1/32).
Findings:
- In contrast to adults, hypoglycaemic children exhibited low plasma insulin concentrations and high plasma ketone levels.
- Elevated plasma lactate and alanine concentrations suggested impaired hepatic gluconeogenesis.
- The findings indicate that malaria-induced hypoglycaemia in African children is primarily due to impaired glucose production, not excessive insulin secretion.
Implications:
- Hypoglycaemia is a critical, treatable manifestation of severe malaria in African children.
- Early recognition and management of hypoglycaemia are crucial for improving outcomes in paediatric malaria.
- The pathogenesis of malaria-induced hypoglycaemia differs between children and adults and is independent of antimalarial treatment.
Abstract:
Hypoglycaemia, defined as a plasma glucose concentration below 2.2 mmol/l, developed in 15 of 47 prospectively studied Gambian children with severe chloroquine-sensitive falciparum malaria. 5 of these hypoglycaemic children died compared with 1 in the normoglycaemic group (p = 0.02). In contrast to previous observations in quinine-treated adults, in whom hypoglycaemia was associated with hyperinsulinaemia, plasma concentrations of insulin were appropriately low and plasma ketones were high. Raised plasma concentrations of lactate and alanine suggested impairment of hepatic gluconeogenesis. In African children, hypoglycaemia is an important and treatable manifestation of severe malaria and is unrelated to antimalarial treatment.