title: Specificity of hypoglycaemia for cerebral malaria in children.
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.
authors.affiliation: Department of Paediatrics, Muhimbili Medical Centre, University of 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: L M
authors.initials: LM
authors.lastname: Chuwa
authors.forename: K G
authors.initials: KG
authors.lastname: Alberti
authors.forename: D G
authors.initials: DG
authors.lastname: McLarty
mesh_terms: D000409:Alanine / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D001927:Brain Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality; D002096:C-Peptide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000097:blood / Q000150:complications / Q000401:mortality; D016002:Discriminant Analysis; D004435:Eating; D005069:Evaluation Studies as Topic; D005230:Fatty Acids, Nonesterified / Q000097:blood; D015600:Glasgow Coma Scale; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000209:etiology / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D008288:Malaria / Q000097:blood* / Q000150:complications / Q000401:mortality; D011379:Prognosis; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D000409:Alanine