Hypoglycaemia and cerebral malaria

Kawo, N.G.; Msengi, A.E.; Swai, A. B. M.; Chuwa, L.M.; Alberti, K. G. M. M.; McLarty, D.G.; Ørskov, Hans

doi:10.1016/0140-6736(90)92602-e

Cited by 8 publications

(17 citation statements)

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“…36,42 Decreased levels of glycemia secondary to the consumption of glucose by the Plasmodium parasite, hyperinsulinism caused by quinine, impaired gluconeogenesis, and lack of adequate supplementation/oral intake are possible explanations in malaria. 37,38,40,43 Independent risk factors associated with hypoglycemia mortality are similar to those found associated with the risk of hypoglycemia. Again, factors related to feeding difficulties or the presence of a clinical condition hindering feeding (unconsciousness, prostration, respiratory distress), malnutrition, and concomitant severe infections (in this case only bacteremia) were all significantly and independently associated with a higher odds of death among patients with hypoglycemia.…”

Section: Discussionsupporting

confidence: 56%

“…39 Studies performed in children with malaria have demonstrated a relationship between fasting, hypoglycemia, severity of disease, and mortality. 7,40 Conditions that decrease consciousness may also result in a prolonged fasting state, explaining the strong association found between consciousness level and the risk of hypoglycemia. However, as hypoglycemia per se is a cause of decreased consciousness, interpreting the direction of the association is not straightforward.…”

Section: Discussionmentioning

confidence: 99%

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Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique

Madrid¹,

Acácio²,

Nhampossa³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Hypoglycemia is a life-threatening complication of several diseases in childhood. We describe the prevalence and incidence of hypoglycemia among admitted Mozambican children, establishing its associated risk factors. We retrospectively reviewed clinical data of 13 years collected through an ongoing systematic morbidity surveillance in Manhiça District Hospital in rural Mozambique. Logistic regression was used to identify risk factors for hypoglycemia and death. Minimum community-based incidence rates (MCBIRs) for hypoglycemia were calculated using data from the demographic surveillance system. Of 49,089 children < 15 years hospitalized in Manhiça District Hospital, 45,573 (92.8%) had a glycemia assessment on admission. A total of 1,478 children (3.2%) presented hypoglycemia (< 3 mmol/L), of which about two-thirds (972) were with levels < 2.5 mmol/L. Independent risk factors for hypoglycemia on admission and death among hypoglycemic children included prostration, unconsciousness, edema, malnutrition, and bacteremia. Hypoglycemic children were significantly more likely to die (odds ratio [OR] = 7.11; P < 0.001), with an associated case fatality rate (CFR) of 19.3% (245/1,267). Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child years at risk (CYAR), significantly decreasing throughout the study period. Newborns showed the highest incidences (9.47 episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a hazardous condition for African children. Symptoms and signs associated to hypoglycemia should trigger the verification of glycemia and the implementation of life-saving corrective measures.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique

Madrid¹,

Acácio²,

Nhampossa³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…54 Gluconeogenic precursors are present in sufficient concentrations to exclude starvation as an etiology; hepatic glycogen stores may be depleted, and gluconeogenesis may be impaired. 40,44,52 Regardless of the etiology, pretreatment hypoglycemia is consistently associated with a poor prognosis (22-37% mortality) in children with CM, 7,40,48 and children with recurrent hypoglycemia fare even worse (71% mortality). 40 The emergency treatment of hypoglycemia is an intravenous infusion of 50% dextrose (1 ml/kg).…”

Section: Pathophysiology Of Fatal Malariamentioning

confidence: 99%

“…In African children, rapid infusions of quinine (Ն 10 mg/kg over a 1-hr period) can also precipitate hypoglycemia, 50 but slower infusion rates and the use of intravenous solutions with dextrose concentrations Ն 5% are safe and well-tolerated. 51 In pretreatment hypoglycemia, in contrast, plasma insulin levels are appropriately low, 40,49,52 and possible mechanisms include impaired production, 53 accelerated metabolism, and/or parasite glucose consumption. 54 Gluconeogenic precursors are present in sufficient concentrations to exclude starvation as an etiology; hepatic glycogen stores may be depleted, and gluconeogenesis may be impaired.…”

Section: Pathophysiology Of Fatal Malariamentioning

confidence: 99%

Pathophysiology of fatal falciparum malaria in African children.

Newton¹,

Taylor²,

Whitten³

1998

Am J Trop Med Hyg

122

121

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Abstract. Children living in sub-Saharan Africa bear the brunt of the mortality from falciparum malaria, yet there is a dearth of relevant post-mortem data. Clinical studies from centers in Africa suggest that the pathophysiology of severe malaria is different in children and adults. Three overlapping clinical syndromes, metabolic acidosis manifesting as hyperpnea, cerebral malaria, and severe anemia, are responsible for nearly all the deaths in African children. Despite improvements in antimalarial treatment, there has not been a significant reduction in mortality. We review the pathology and pathophysiology of fatal falciparum malaria in African children. Many questions remain, the answers to which would facilitate the development and evaluation of new approaches to the management of this disease.Severe and complicated Plasmodium falciparum infections continue to threaten the survival of young children in sub-Saharan Africa: one in 15 children on the Kenyan coast will have experienced an episode of severe malaria before the age of five, 1 and 1% of Gambian children less than five years of age will die of malaria. 2 The annual death toll is estimated to be one million children across the continent; 90% of the annual worldwide malaria mortality. 3 Although most children die in the community, on the Kenyan coast it is estimated that more than 40% die in a hospital (Marsh K, unpublished data) and one-third of pediatric hospital admissions and one-third of pediatric hospital deaths in Malawi can be attributed to malaria. 4

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“…Decreased levels of glycaemia secondary to the consumption of glucose by the Plasmodium parasite, hyperinsulinism caused by quinine, impaired gluconeogenesis and lack of adequate supplementation/oral intake are possible explanations in cases of severe malaria or even uncomplicated malaria [38,[52][53][54].…”

Section: -The Pathophysiology Of Malaria-related Hypoglycaemia Manymentioning

confidence: 99%