Hypoglycaemia and counterregulatory hormone responses in severe falciparum malaria: treatment with Sandostatin.

Journal article

The mechanism and response to treatment of severe life-threatening hypoglycaemia (plasma glucose 1.15 +/- 0.73 mM/l [+/- SD]) was studied in eight Thai patients with falciparum malaria. Plasma insulin concentrations were inappropriately high (range 1.0-21.8 mU/l), lactic acidosis was common (arterial blood lactic acid concentration 1.44-17.8 mM/l), but the glucose counterregulatory response, indicated by plasma cortisol, growth hormone, catecholamines and glucagon concentrations, was intact. Hyperinsulinaemia was successfully treated in five patients by a continuous intravenous infusion of the long-acting somatostatin analogue Sandostatin (SMS 201-995), 50 micrograms/h. In volunteer studies a single intramuscular injection of Sandostatin (100 micrograms) suppressed quinine-induced hyperinsulinaemia within 15 min; this effect was maintained for 6 h. These results suggest that Sandostatin may be a safe and effective way of correcting the hyperinsulinaemic hypoglycaemia complicating quinine treatment of falciparum malaria. This treatment could be particularly useful in fluid-overloaded patients with recurrent hypoglycaemia despite dextrose infusions.

Authors: Phillips, R; Looareesuwan, S; Molyneux, M; Hatz, C; Warrell, D

• Publication status: Published
• Journal: Quarterly journal of medicine
• Volume: 86
• Issue: 4
• Pages: 233-240
• Publication date: 1993-04-01
• ISSN: 0033-5622
• Language: English
• Keywords: Quinine; Peritoneal Dialysis; Malaria, Falciparum; Insulin; Octreotide; Humans; Adult; Female; Male; Glucagon; Adolescent; Hypoglycemia; Glucose Solution, Hypertonic