Publication: Severe Hypoglycemia and Hyperinsulinemia in Falciparum Malaria
Issued Date
1983-07-14
Resource Type
ISSN
15334406
00284793
00284793
Other identifier(s)
2-s2.0-0020637143
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
New England Journal of Medicine. Vol.309, No.2 (1983), 61-66
Suggested Citation
Nicholas J. White, David A. Warrell, Pornthep Chanthavanich, Sornchai Looareesuwan, M. J. Warrell, Sanjeev Krishna, Dermot H. Williamson, Robert C. Turner Severe Hypoglycemia and Hyperinsulinemia in Falciparum Malaria. New England Journal of Medicine. Vol.309, No.2 (1983), 61-66. doi:10.1056/NEJM198307143090201 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/30506
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Title
Severe Hypoglycemia and Hyperinsulinemia in Falciparum Malaria
Abstract
We studied the occurrence, clinical manifestations, and mechanism of hypoglycemia in patients with falciparum malaria in eastern Thailand. Hypoglycemia, which was often severe and recurrent, occurred in 17 patients, including 12 in a series of 151 patients with cerebral malaria. Thirty episodes were investigated. Plasma concentrations of insulin and C peptide were inappropriately high, and lactate and alanine concentrations were significantly higher than in patients with falciparum malaria who were normoglycemic (P<0.05). Sixteen patients had received quinine; plasma quinine and insulin concentrations were correlated at the time of hypoglycemia (P = 0.007). In seven healthy fasting volunteers intravenous quinine increased the mean plasma insulin concentration (±S.D.) from 8.9±3.1 to 17.1±8.4 mU per liter (P = 0.02) and reduced the mean plasma glucose concentration from 88±20 to 68±23 mg per deciliter (P = 0.002). Our observations indicate that in falciparum malaria quinine-induced insulin secretion may precipitate hypoglycemia, but other factors, including the large glucose requirements of the malaria parasites may also contribute. This important complication, associated with pregnancy and severe disease, must be excluded in all patients with falciparum malaria who have impaired or deteriorating consciousness. (N Engl J Med 1983; 309:61–6). © 1983, Massachusetts Medical Society. All rights reserved.