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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Hypoglycaemia in severe malaria, clinical associations and relationship to quinine dosage
BMC Infectious Diseases, Volume 10, Article 334, Year 2010
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Description
Background: Hypoglycaemia is an independent risk factor for death in severe malaria and a recognized adverse treatment effect of parenteral quinine. In 2006 our hospital changed quinine treatment policy from 15 mg/kg loading (plus 10 mg/kg 12-hourly) to 20 mg/kg loading (plus 10 mg/kg 8-hourly) to comply with new WHO guidelines. This presented us with the opportunity to examine whether there was any dose relationship of quinine and hypoglycaemia occurrence.Methods: Retrospective case notes review of all children admitted to hospital with severe falciparum malaria between April 2002 - July 2009, before and after the introduction of the new WHO quinine regimen. Four-hourly bedside glucose levels were measured until intravenous quinine was discontinued. Clinical events immediately preceding or concurrent with each episode of hypoglycaemia (glucose < = 3.0 mmol/l) were recorded.Results: 954 children received the old quinine regime and 283 received the new regime. We found no evidence of an increased prevalence of hypoglycaemia (< = 3.0 mmol/L) on the new regime compared to former (15% vs. 15%); similar findings were noted for profound hypoglycaemia (< 2.2 mmols/L) 8% v 5%, P = 0.07. Episodes were co-incident with disease severity markers: coma (57%), circulatory failure (38%) and respiratory distress (21%) but less commonly with seizures (10%). Disruption of maintenance fluids and/or blood transfusion concurred with 42% of the hypoglycaemia episodes. Post admission hypoglycaemia increased odds of fatal outcome (24%) compared to euglycaemic counterparts (8%), odds ratio = 3.45 (95% confidence interval = 2.30-5.16) P < 0.01.Conclusion: There was no evidence to indicate a dose relationship between quinine and occurrence of hypoglycaemia. Hypoglycaemia concurred with severity features, disruption of glucose infusion and transfusion. Careful glucose monitoring should be targeted to these complications where resources are limited. © 2010 Ogetii et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Ogetii, Gilbert N.
Kenya, Kilifi
Centre for Geographic Medicine Research
Akech, Samuel O.
Kenya, Kilifi
Centre for Geographic Medicine Research
Jemutai, Julie
Kenya, Kilifi
Centre for Geographic Medicine Research
Boga, Mwanamvua
Kenya, Kilifi
Centre for Geographic Medicine Research
Kivaya, Esther
Kenya, Kilifi
Centre for Geographic Medicine Research
Fegan, Greg
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Oxford
Nuffield Department of Medicine
Maitland, Kathryn M.
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, London
Wellcome Trust
Statistics
Citations: 62
Authors: 7
Affiliations: 3
Identifiers
Doi:
10.1186/1471-2334-10-334
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Quasi Experimental Study
Case-Control Study