HYPOGLYCEMIA AND COUNTERREGULATORY HORMONE RESPONSES IN SEVERE FALCIPARUM-MALARIA - TREATMENT WITH SANDOSTATIN

The mechanism and response to treatment of severe life-threatening hyp oglycaemia (plasma glucose 1.15+/-0.73 mM/l [+/-SD]) was studied in ei ght Thai patients with falciparum malaria. Plasma insulin concentratio ns were inappropriately high (range 1.0-21.8 mU/l), lactic acidosis wa s common (arterial blood lactic acid concentration 1.44-17.8 mM/l), bu t the glucose counterregulatory response, indicated by plasma cortisol , growth hormone, catecholamines and glucagon concentrations, was inta ct. Hyperinsulinaemia was successfully treated in five patients by a c ontinuous intravenous infusion of the long-acting somatostatin analogu e Sandostatin (SMS 201-995), 50 mug/h. In volunteer studies a single i ntramuscular injection of Sandostatin (100 mug) suppressed quinine-ind uced hyper-insulinaemia within 15 min; this effect was maintained for 6 h. These results suggest that Sandostatin may be a safe and effectiv e way of correcting the hyperinsulinaemic hypoglycaemia complicating q uinine treatment of falciparum malaria. This treatment could be partic ularly useful in fluid-overloaded patients with recurrent hypoglycaemi a despite dextrose infusions.