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Title: Lactic acidosis and hypoglycaemia in children with severe malaria: Pathophysiological and prognostic significance
Authors: S. Krishna
D. W. Wailer
F. Ter Kuile
D. Kwiatkowski
J. Crawley
C. F.C. Craddock
F. Nosten
D. Chapman
D. Brewster
P. A. Holloway
N. J. White
Mahidol University
John Radcliffe Hospital
Medical Research Council Laboratories Gambia
University of Amsterdam
John Hunter Hospital
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Jan-1994
Citation: Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.88, No.1 (1994), 67-73
Abstract: Serial clinical and metabolic changes were monitored in 115 Gambian children (1·5–12 years old) with severe malaria. Fifty-three children (46%) had cerebral malaria (coma score < /2) and 21 (18%) died. Admission geometric mean venous blood lactate concentrations were almost twice as high in fatal cases as in survivors (7·1 mmol/L vs. 3·6 mmol/L; P < 0·001) and were correlated with levels of tumour necrosis factor (r = 0·42, n = 79; P < 0·0001) and interleukin 1-α (r = 0·6, n = 34; P < 0·0001). Admission blood venous glucose concentrations were lower in fatal cases than survivors (3·2 mmol/L, vs. 5·8 mmol/L; P < 0·0001). Treatment with quinine was associated with significantly more episodes of post-admission hypoglycaemia when compared with artemether or chloroquine. After treatment, lactate concentrations fell rapidly in survivors but fell only slightly, or rose, in fatal cases. Plasma cytokine levels fluctuated widely after admission. Sustained hyperlactataemia (raised lactate concentrations, 4 h after admission) proved to be the best overall prognostic indicator of outcome in this series. Lactic acidosis is an important cause of death in severe malaria. © 1994 Oxford University Press.
ISSN: 18783503
Appears in Collections:Scopus 1991-2000

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