title: The metabolic effects of quinine in children with severe and complicated Plasmodium falciparum malaria in Dar es Salaam.
abstract: Quinine is widely used for the treatment of severe and complicated malaria, although resistant strains of Plasmodium falciparum may occur. The drug has been incriminated as a cause of hypoglycaemia in some malaria patients. To determine if quinine has untoward metabolic effects during treatment of severe and complicated malaria we have studied the effects of quinine on blood glucose and intermediary metabolites, serum insulin, C-peptide, plasma glucagon and non-esterified fatty acids in 97 children with severe malaria in Dar es Salaam. All patients responded clinically. No patient developed hypoglycaemia while on quinine therapy given as 10 mg/kg in 10 ml/kg of 5% dextrose infused over 4 h every 8 h. Endogenous insulin secretion, as reflected by C-peptide levels, increased after 4 h but insulin levels did not change significantly. Blood lactate, 3-hydroxybutyrate, plasma non-esterified fatty acids and plasma glucagon all fell appropriately during treatment. We conclude that quinine, when administered at the recommended dose and rate, does not disrupt blood glucose homeostasis, and is still the drug of choice for severe and complicated malaria in children.
authors.affiliation: Department of Paediatrics, Muhimbili Medical Centre, Dar es Salaam, Tanzania.
authors.forename: N G
authors.initials: NG
authors.lastname: Kawo
authors.forename: A E
authors.initials: AE
authors.lastname: Msengi
authors.forename: A B
authors.initials: AB
authors.lastname: Swai
authors.forename: H
authors.initials: H
authors.lastname: Orskov
authors.forename: K G
authors.initials: KG
authors.lastname: Alberti
authors.forename: D G
authors.initials: DG
authors.lastname: McLarty
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D002096:C-Peptide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D007223:Infant; D007328:Insulin / Q000097:blood; D007773:Lactates / Q000097:blood; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy*; D008297:Male; D011803:Quinine / Q000009:adverse effects*; D013636:Tanzania
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D005230:Fatty Acids, Nonesterified; D006885:Hydroxybutyrates; D007328:Insulin; D007773:Lactates; D005934:Glucagon; D011803:Quinine