Publication: Lactic acidosis and hypoglycaemia in children with severe malaria: Pathophysiological and prognostic significance
Issued Date
1994-01-01
Resource Type
ISSN
18783503
00359203
00359203
Other identifier(s)
2-s2.0-0028156942
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.88, No.1 (1994), 67-73
Suggested Citation
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 Lactic acidosis and hypoglycaemia in children with severe malaria: Pathophysiological and prognostic significance. Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.88, No.1 (1994), 67-73. doi:10.1016/0035-9203(94)90504-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/9605
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Title
Lactic acidosis and hypoglycaemia in children with severe malaria: Pathophysiological and prognostic significance
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.