Glycerol metabolism in severe falciparum malaria.
Gluconeogenesis and liver blood flow (LBF) in severe falciparum malaria were assessed from the clearance and metabolic response to intravenously administered glycerol (0.3 g/kg) and Indocyanine Green ([ICG] 0.4 mg/kg), respectively. Fasting baseline blood glycerol concentrations (mean +/- SD) were significantly higher in acute malaria (133 +/- 65 mumol/L, n = 14), than in convalescence (65 +/- 31 mumol/L, n = 9, P = .01), but basal triacylglycerol concentrations were similar. Estimated glycerol turnover was also more than twice as high in acute malaria compared with convalescence (1.36 +/- 0.87 v 0.54 +/- 0.15 mumol.min-1.kg-1, P = .015). The increment in plasma glucose (AUC0-55 min) following glycerol infusion was greater during acute malaria compared with convalescence (median [range], +31.6 [-0.9 to +107.6] v +14.5 [-103 to +27.1] mmol.min-L-1, P < .05), but the insulin increments were similar (P = .9), indicating reduced tissue insulin sensitivity. The increment in venous lactate (AUC0-55 min) was higher in severely ill patients (17.2 [-7.8 to +53.4] mmol.min.L-1, n = 10) compared with patients with moderately severe malaria (-3.1 [-8.7 to 3.2] mmol.min-L-1, n = 4, P = .01). LBF estimated from ICG clearance was lower during acute illness than in convalescence (mean +/- SD, 15.5 +/- 2.3 v 18.6 +/- 2.9 mL.min-1.kg-1, P = .007) and correlated inversely with the basal venous lactate concentration (rs = .53, P < .05). LBFs less than 15 mL.min-1.kg-1 were associated with hyperlactatemia, and all four fatal cases had LBFs of less than 12 mL.min-1.kg-1.(ABSTRACT TRUNCATED AT 250 WORDS)
Pukrittayakamee
S
S
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
White
N J
NJ
Davis
T M
TM
Supanaranond
W
W
Crawley
J
J
Nagachinta
B
B
Williamson
D H
DH
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D005690:Galactose / Q000493:pharmacokinetics; D005990:Glycerol / Q000097:blood / Q000378:metabolism* / Q000494:pharmacology; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D007700:Kinetics; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008102:Liver Circulation; D016778:Malaria, Falciparum / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D007773:Lactates; D019344:Lactic Acid; D007208:Indocyanine Green; D005990:Glycerol; D005690:Galactose