Glucose and Lactate Kinetics in Children with Severe Malaria

摘要: Children with severe malaria often present lactic acidosis and hypoglycemia. Although both complications independently predict mortality, mechanisms underlying their development are poorly understood. To study these metabolic derangements we sequentially allocated 21 children falciparum capillary lactate concentrations of 5 mmol/L or more to receive either quinine artesunate as antimalarial therapy, dichloroacetate saline placebo for acidosis. We then administered a primed infusion (90 min) l-[3-13C1]sodium d-[6,6-D2]glucose determine the kinetics substrates. The mean (sd) glucose disposal rate in all patients was 56 (16) μmol/kg·min, geometric (range) 100 (66–177)μ mol/kg·min. Glucose rates were positively correlated (r = 0.62; P 0.005). Artesunate associated faster parasite clearance, lower insulin/glucose ratios, higher than quinine. Lactate...