Q J Med 2001; 94: 709-715
© 2001 Association of Physicians
Glucose production and gluconeogenesis in adults with cerebral malaria
From the 1 Bao Loc General Hospital, Lamdong Province, Vietnam, Departments of 2 Clinical Chemistry, Laboratory of Endocrinology and Radiochemistry, 3 Internal Medicine, 4 Infectious Diseases, Tropical Medicine and AIDS, and 5 Endocrinology and Metabolism, Academic Medical Centre, Amsterdam, The Netherlands, 6 Director of Health Service of Lamdong Province, Vietnam, 7 Department of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
Received 20 June 2001 and in revised form 4 October 2001
Hypoglycaemia is an important complication in severe malaria, ascribed to an inhibition of gluconeogenesis. However, the only data available suggested that in severe malaria, total glucose production is increased. We measured glucose production and gluconeogenesis after an overnight fast in all seven patients with cerebral malaria (CM) consecutively admitted to Bao Loc General hospital over a 2-year period, and in six healthy sex- and age-matched controls. Glucose production was measured by infusion of [6,6–2H2]glucose and the contribution of gluconeogenesis by oral ingestion of 2H2O. Compared to controls, plasma glucose concentration was 42% higher in CM patients (p=0.004), and glucose production was doubled (p=0.003). Gluconeogenesis contributed 100% of the total glucose in CM patients but only 58% in controls (p=0.003). The plasma concentrations of the substrates for gluconeogenesis and the glucoregulatory hormones were not different between patients and controls, except for an increase in lactate and cortisol in the patients. Cerebral malaria is associated with increases rather than decreases in plasma glucose, glucose production and gluconeogenesis, and there is no contribution of glycogenolysis to glucose production. Factors other than malaria per se are involved in the pathogenesis of hypoglycaemia associated with CM.
Address correspondence to Professor Dr H.P. Sauerwein, Department of Endocrinology and Metabolism, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands. e-mail: h.p.sauerwein{at}amc.uva.nl
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