The metabolic effects of quinine in children with severe and complicated Plasmodium falciparum malaria in Dar es Salaam

Abstract

Quinine is widely used for the treatment of severe and complicated malaria, although resistant strains of Plasmodium falciparum may occur. The drug has been incriminated as a cause of hypoglycaemia in some malaria patients. To determine if quinine has untoward metabolic effects during treatment of severe and complicated malaria we have studied the effects of quinine on blood glucose and intermediary metabolites, serum insulin, C-peptide, plasma glucagon and non-esterified fatty acids in 97 children with severe malaria in Dar es Salaam. All patients responded clinically. No patient developed hypoglycaemia while on quinine therapy given as 10 mg/kg in 10 ml/kg of 5% dextrose infused over 4 h every 8 h. Endogenous insulin secretion, as reflected by C-peptide levels, increased after 4 h but insulin levels did not change significantly. Blood lactate, 3-hydroxybutyrate, plasma non-esterified fatty acids and plasma glucagon all fell appropriately during treatment. We conclude that quinine, when administered at the recommended dose and rate, does not disrupt blood glucose homeostasis, and is still the drug of choice for severe and complicated malaria in children.

Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana

“…Abdallah et al [ 22 ] observed hypoglycemia in 12% of adult subjects receiving intravenous quinine for severe malaria. However, Kawo et al [ 23 ] did not observe significant changes in blood glucose in subjects with falciparum malaria receiving intravenous administration of quinine.…”

A Clinical Study of Falciparum Malaria - 302 Cases

“…In none of our cases, hypoglycaemia could be established . Kawo et al [12], in their study of 97 Tanzanian children found hypoglycaemia in none of the cases on admission and after quinine infusion. The said study was faulted by White' [13], for its design and patient study group (no case of severe falciparum malaria) which were refuted by the author.…”

Clinical outcome of dysglycaemia in children admitted to pediatric ward at a tertiary care hospital - a prospective study

“…Abdallah et al [21] observed hypoglycemia in 12% of adult subjects receiving intravenous quinine for severe malaria. However, Kawo et al [22] did not observe significant changes in blood glucose in subjects with falciparum malaria receiving intravenous administration of quinine.…”