Frequency of Hypoglycemia in Severe Malaria in Children Aged 5 To 144 Months In Kinshasa

Background: Hypoglycemia is an important complication of severe malaria, especially in children and pregnant women.   In 2017 Kikimi  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 hypoglycemia occurrence, in particular, in severe malaria in children from 5 to 144 months.

Methods: The study was retrospective of children aged 5 to 144 months admitted to KIkimi hospital with severe malaria between April 2017 and July 2018, before and after the introduction of the new quinine treatment regimen by the WHO. The patient's blood glucose at four hours was measured until intravenous quinine was stopped. Clinical events immediately before or simultaneously with each episode of hypoglycemia (glucose <= 3.0 mmol / l) were recorded.

Results: Age group at high parasitemia was 13 to 48 months and165 children received the old quinine diet and 125 the new diet. We found no evidence of an increase in the prevalence of hypoglycemia (<= 3.0 mmol / L) with the new regimen compared with the old one (15% versus 15%); similar results were noted for deep hypoglycaemia (<2.2 mmol / L) 9% v 6%, p = 0.09. The episodes coincided with the indicators of the severity of the disease: coma (55%), circulatory insufficiency (36%) and respiratory distress (19%), but less frequently with convulsions (11).

Conclusion: With a single case of malaria falciparum infection with high parasitemia in children aged 13 to 48 months. There was no evidence to indicate a dose relationship between quinine and the occurrence of hypoglycemia. Hypoglycemia was associated with disruption of glucose perfusion and transfusion. Close monitoring of blood glucose should be targeted during complications in children who remain seriously ill.