Glucose turnover in pregnant women with acute malaria.
1. Hypoglycaemia is a serious complication of falciparum malaria, especially in pregnant patients. To investigate malaria-associated changes in glucose metabolism in pregnancy, steady-state [6,6-2H2] glucose turnover and clearance were measured in 10 women (eight with uncomplicated falciparum malaria and two with vivax malaria at 16-30 weeks gestation) before treatment, after intravenous quinine infusion (patients with falciparum malaria) and in convalescence. 2. Admission basal plasma glucose concentrations were higher than those in convalescence [median (range); 4.8 (3.6-7.0) versus 4.0 (3.6-4.6) mmol/l, P = 0.02], and there was a significant fall during initial quinine treatment in patients with falciparum malaria [5.0 (4.3-7.6) to 3.6 (3.2-5.4) mmol/l, P < 0.01]. Basal plasma insulin levels were comparable at presentation and follow-up (P = 0.35) and rose an average of only 2m-units/l during quinine infusion (P < 0.05). Pretreatment glucose turnover rates [3.37 (2.57-4.16) mg min-1 kg-1] were comparable with those found in a previously reported study of non-pregnant severely ill patients [3.22 (2.12-4.82) mg min-1 kg-1, n = 11] and correlated significantly with the admission parasitaemia (P < 0.025). In the eight patients with falciparum malaria, there was a significant fall in turnover during intravenous quinine infusion [3.42 (2.58-4.16) to 2.66 [1.94-3.94) mg min-1 kg-1] whereas clearance did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
Davis
T M
TM
Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Suputtamongkol
Y
Y
Spencer
J L
JL
Wilson
S G
SG
Mekhton
S
S
Croft
K D
KD
White
N J
NJ
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000378:metabolism*; D016780:Malaria, Vivax / Q000188:drug therapy / Q000378:metabolism*; D008657:Metabolic Clearance Rate / Q000502:physiology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000378:metabolism*; D011803:Quinine / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D014280:Triglycerides; D011803:Quinine