Hypoglycaemia (blood glucose concentration ^2.2mmol/l or 40mg/dl) is generally associated with quinine infusion in adults and is most often attributed to quinine-induced hyperinsulinaemia, although other mechanisms, such as the effect of circulating cytokines, are likely to be involved. In children, pretreatment of hypoglycaemia is important. It is present in 10-20% of African children on presentation with cerebral malaria and is associated with a poor prognosis (Newton et al., 1998). High parasitaemias contribute to hypoglycaemia and probably also to lactic acidosis. Parasites consume glucose at a rate of 70 times that of erythrocytes to generate energy from anaerobic glycolysis of glucose to lactic acid. Sick patients are also likely to have high levels of circulating cytokines, which also contribute to the abnormal metabolic state (White et al., 1983; Krishna et al., 1994).
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