title: Hypoglycaemia and counterregulatory hormone responses in severe falciparum malaria: treatment with Sandostatin.
abstract: The mechanism and response to treatment of severe life-threatening hypoglycaemia (plasma glucose 1.15 +/- 0.73 mM/l [+/- SD]) was studied in eight Thai patients with falciparum malaria. Plasma insulin concentrations were inappropriately high (range 1.0-21.8 mU/l), lactic acidosis was common (arterial blood lactic acid concentration 1.44-17.8 mM/l), but the glucose counterregulatory response, indicated by plasma cortisol, growth hormone, catecholamines and glucagon concentrations, was intact. Hyperinsulinaemia was successfully treated in five patients by a continuous intravenous infusion of the long-acting somatostatin analogue Sandostatin (SMS 201-995), 50 micrograms/h. In volunteer studies a single intramuscular injection of Sandostatin (100 micrograms) suppressed quinine-induced hyperinsulinaemia within 15 min; this effect was maintained for 6 h. These results suggest that Sandostatin may be a safe and effective way of correcting the hyperinsulinaemic hypoglycaemia complicating quinine treatment of falciparum malaria. This treatment could be particularly useful in fluid-overloaded patients with recurrent hypoglycaemia despite dextrose infusions.
authors.affiliation: Centre for Tropical Medicine, University of Oxford.
authors.forename: R E
authors.initials: RE
authors.lastname: Phillips
authors.forename: S
authors.initials: S
authors.lastname: Looareesuwan
authors.forename: M E
authors.initials: ME
authors.lastname: Molyneux
authors.forename: C
authors.initials: C
authors.lastname: Hatz
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005934:Glucagon / Q000097:blood; D005950:Glucose Solution, Hypertonic; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D007328:Insulin / Q000097:blood*; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*; D010530:Peritoneal Dialysis; D011803:Quinine / Q000009:adverse effects / Q000097:blood
chemical_list: D005950:Glucose Solution, Hypertonic; D007328:Insulin; D005934:Glucagon; D011803:Quinine; D015282:Octreotide