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Title: Glucose and lactate kinetics in children with severe malaria
Authors: Tsiri Agbenyega
Brian J. Angus
George Bedu-Addo
Benjamin Baffoe-Bonnie
Tom Guyton
Peter W. Stacpoole
Sanjeev Krishna
Kwame Nkrumah University of Science and Technology
Komfo Anokye Teaching Hospital
St George's University of London
Mahidol University
University of Florida College of Medicine
University of Florida
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 1-Dec-2000
Citation: Journal of Clinical Endocrinology and Metabolism. Vol.85, No.4 (2000), 1569-1576
Abstract: Children with severe malaria often present with lactic acidosis and hypoglycemia. Although both complications independently predict mortality, mechanisms underlying their development are poorly understood. To study these metabolic derangements we sequentially allocated 21 children with falciparum malaria and capillary lactate concentrations of 5 mmol/L or more to receive either quinine or artesunate as antimalarial therapy, and dichloroacetate or saline placebo for lactic acidosis. We then administered a primed infusion (90 min) of L-[3-13C1]sodium lactate and D-[6,6-D2]glucose to determine the kinetics of these substrates. The mean (SD) glucose disposal rate in all patients was 56 (16) μmol/kg·min, and the geometric mean (range) lactate disposal rate was 100 (66-177) μmol/kg·min. Glucose and lactate disposal rates were positively correlated (r = 0.62; P = 0.005). Artesunate was associated with faster parasite clearance, lower insulin/glucose ratios, and higher glucose disposal rates than quinine. Lactate disposal was positively correlated with plasma lactate concentrations (r = 0.66; P = 0.002) and time to recovery from coma (r = 0.82; P < 0.001; n = 15). Basal lactate disposal rates increased with dichloroacetate treatment. Elevated glucose turnover in severe malaria mainly results from enhanced anaerobic glycolysis. Quinine differs from artesunate in its effects on glucose kinetics. Increased lactate production is the most important determinant of lactic acidosis.
ISSN: 0021972X
Appears in Collections:Scopus 1991-2000

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