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Glucose Kinetics during Fasting in Young Children with Severe and Non-severe Malaria in Suriname

Fasting could be an important factor in the induction of hypoglycemia in children with malaria because fasting results in a decrease in endogenous glucose production. The influence of extended fasting on plasma glucose concentration, glucose production, and gluconeogenesis were measured using [6,6-²H₂]glucose and ²H₂O in 12 Surinamese children with severe malaria and compared with 16 children with non-severe malaria during a 16-hour controlled fast. Glucose concentration and glucose production were comparable after 8 hours of fasting and decreased in both groups (P < 0.001) with an extension of the fast up to 16 hours. Glucose concentration decreased faster in the non-severe group than in the severe group (P = 0.029). The decrease in glucose production was not different between groups (P = 0.954). Thus, fasting predisposes for hypoglycemia in young children with Plasmodium falciparum malaria. Hypoglycemia caused by fasting develops later in young children with severe malaria than in children with non-severe malaria.

Received January 26, 2008. Accepted for publication July 8, 2008.

Acknowledgments: We thank Michael Tanck (Department of Clinical Epidemiology and Biostatistics Academic Medical Center Amsterdam) for excellent support on statistical analyses; the Medical Mission in Surinam, especially Dr. Thompson Danzo (Distrikt Hospital Stoelmanseiland); Vera Kranenburg (Diakonessen Hospital); the Nursing staff of the children’s ward of Diakonessen Hospital; the technicians at the Endocrinology Laboratory at the Academical Medical Centre, especially An Ruiter; and the Parasitology Laboratory at the Academical Medical Centre for their assistance; and Theunis Eggelte for providing the quinine dipsticks.

Financial support: This study was supported by the Foundation De Drie Lichten in The Netherlands and the Stichting tot Steun Emma Children’s Hospital Academical Medical Centre, Amsterdam, The Netherlands.

^* Address correspondence to Wilco Zijlmans, Department of Pediatrics, Diakonessen Hospital, PO Box 1814, Paramaribo, Suriname. E-mail: zijlmans.dams{at}sr.net

Authors’ addresses: Wilco Zijlmans, Department of Pediatrics, Diakonessen Hospital, PO Box 1814, Paramaribo, Suriname, Tel: 597-860-0200, Fax: 597-499-224, E-mail: zijlmans.dams{at}sr.net. Anne van Kempen, Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands, Tel: 31-20-599-3528, Fax: 31-20-599-3987, E-mail: a.vankempen{at}olvg.nl. Mariëtte Ackermans, Department of Clinical Chemistry, Laboratory of Endocrinology and Radiochemistry, Academic Medical Center, Amsterdam, The Netherlands, Tel: 31-20-566-5924, Fax: 31-20-697-7963, E-mail: m.t.ackermans{at}amc.uva.nl. Jesse de Metz, Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands, Tel: 31-20-566-9111, Fax: 31-20-566-9568, E-mail: j.demetz{at}amc.uva.nl. Piet Kager, Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands, Tel: 31-20-566-4380, Fax: 31-20-697-2286, E-mail: P.A.Kager{at}amc.uva.nl. Hans Sauerwein, Metabolism Unit, Department of Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands, Tel: 31-20-566-3061, Fax: 31-20-691-7682, E-mail: H.P.Sauerwein{at}amc.uva.nl.