Quinine and Severe Falciparum Malaria in Late Pregnancy

Looareesuwan, Sornchai; White, Nicholas J.; Karbwang, Juntra; Turner, R. Elaine; Phillips, R E; Kietinun, Somboon; Rackow, Chloë; Warrell, D A

doi:10.1016/s0140-6736(85)90056-x

Cited by 181 publications

(73 citation statements)

References 15 publications

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“…In severe falciparum malaria, hypoglycaemia is a common and serious complication (White et al 1983), especially in children (White et al 1987) and pregnant women (Looareesuwan et al 1985). The mortality rate increases four-to six-fold in children when malaria is complicated with hypoglycaemia (Marsh et al 1995;Schellenberg et al 1999).…”

Section: Introductionmentioning

confidence: 99%

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

Zijlmans

Kempen

Ackermans

et al. 2008

Tropical Med Int Health

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Summaryobjective To measure glucose kinetics and the influence of age, nutritional status and fasting duration in children with uncomplicated falciparum malaria (UFM) under the age of 5 years. results Plasma glucose concentration was lower in the group of very young children than in the older children (P = 0.028). There were no differences in EGP and GNG between the groups. Overall GNG contributed 56% (median, range 17-87%) to EGP, with no differences between the groups (P = 0.240).Glucose clearance was lower in the older children (P = 0.026). Glucose concentration did not differ between children with weight for length ⁄ height less than )1.3 SD and children with weight for length ⁄ height greater than )1.3 SD (P = 0.266). Plasma glucose concentration was not predicted by fasting duration (P = 0.762).conclusions Our data suggest a higher risk of hypoglycaemia in very young children with uncomplicated malaria as plasma glucose concentration was lower in this study group. Since this could not be attributed to an impaired EGP, and because glucose clearance was lower in the older children, we presume that older children were better capable of reducing glucose utilization during fasting. Studies on glucose kinetics are feasible in very young children with malaria and give more insight in the pathophysiology of hypoglycaemia.

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Section: Introductionmentioning

confidence: 99%

Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname

Zijlmans

Kempen

Ackermans

et al. 2008

Tropical Med Int Health

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“…Intravenous quinine fusions should be given slowly but if the minimum inhibitory concentration of quinine for Southeast Asian strains of P. falciparum (Chongsuphajaisiddhi etal., 1981) is to be reached and sustained during the early critical phase of treatment, a loading dose, without reduction in maintenance doses, is necessary. Fears that in late pregnancy these quinine doses would start uterine contraction or kill the foetus have not been substantiated (Looareesuwan et al, 1985a). Although quinine stimulated insulin release is an important toxic effect, the benefits of chemotherapy with quinine clearly overshadow the risks of malaria treated inadequately.…”

Section: Discussionmentioning

confidence: 99%

“…At Pra Pokklao Hospital chloroquine resistance is well established (Phillips et al, 1984;Looareesuwan et al, 1985a) and quinine was the only antimalarial available to treat falciparum malaria in pregnancy. Patients who required parenteral treatment were given quinine dihydrochloride (Government Pharmaceutical Organisation, Thailand) initial dose either 10 or 20 mg of the salt kg-' (equivalent to 8.3 and 16.7 mg base kg-', respectively) diluted in 500 ml of 0.9% normal saline and infused over 4 h followed by further 4 h infusions of 10 mg of the salt kg-' every 8 h. Patients received a loading dose (20 mg kg-') if they were assessed clinically as having life-threatening falciparum malaria and there was no possibility of quinine treatment in the preceding 48 h. Convalescent patients and those with uncomplicated malaria took the maintenance dose as quinine sulphate tablets until a 7-day course was completed.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Quinine pharmacokinetics and toxicity in pregnant and lactating women with falciparum malaria.

Phillips¹,

Looareesuwan²,

White³

et al. 1986

Brit J Clinical Pharma

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1 Quinine dihydrochloride (10 mg or, in two patients, a loading dose of 20 mg kg-) was infused intravenously over 4 h in ten severely ill but conscious women with falciparum malaria complicating the third trimester of pregnancy. 2 Plasma quinine concentrations, measured spectrophotofluorimetrically after benzene extraction, fitted closely a single exponential decline after the intravenous infusion. These data were therefore fitted to a one compartment model: total apparent volume of distribution, V, 0.96 + 0.271 kg-' (+ s.d.), elimination half-time (t112,z), 11.3 ± 4.3 h, total clearance, 1.22 + 0.77 ml min7l kg-. There was no relationship between arterial blood pressure and plasma quinine concentrations. 3 Eight women delivered of live infants while taking quinine, had placental cord plasma quinine concentrations from 1.0 to 4.6 mg 1-1 (mean 2.4) which correlated significantly with maternal plasma quinine concentrations (r = 0.78, t = 3.06, P < 0.05). The mean (+ s.d.) ratio of cord plasma to maternal plasma quinine concentration was 0.32 + 0.14.Heart blood from a foetus aborted at term had a plasma quinine concentration of 2.8 mg 171; simultaneous maternal plasma quinine was 7.1 mg 1-1 (ratio 0.39). 4 Breast milk quinine concentrations and milk to plasma ratios were 0.5-3.6 mg 1-1 (mean 2.6) and 0.11-0.53 (mean 0.31) in twenty-five women who were breast-feeding and had taken oral quinine sulphate for 1-10 days (mean 4.0). Five women with more serious infections received intravenous quinine; breast milk quinine concentrations ranged between 0.5 and 8.0 mg 171 (mean 3.4). Corresponding milk to plasma ratios were 0.11 to 0.32 (mean 0.21).

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“…Both quinine and quinidine including hydroxychloroquine may cause or aggravate hypoglycemia by stimulating insulin secretion, but quinine's effect is more potent [113,114].…”

Section: Quininesmentioning

confidence: 99%