GLUCOSE-PRODUCTION AND GLUCONEOGENESIS IN ADULTS WITH UNCOMPLICATED FALCIPARUM-MALARIA

Although glucose production is increased in severe malaria, the influe nce of uncomplicated malaria on glucose production is unknown. Therefo re, we measured in eight adult Vietnamese patients with uncomplicated falciparum malaria and eight healthy Vietnamese controls glucose produ ction (by infusion of [6,6-H-2(2)]glucose) and the fractional contribu tion of gluconeogenesis (by oral ingestion of (H2O)-H-2); glycogenolys is was calculated as the difference between the two. After 20 h of fas ting, plasma glucose was 4.7 +/- 0.2 mmol/l in the patients and 4.3 +/ - 0.2 mmol/l in the controls (not significant). Glucose production was similar to 25% higher in the patients (16.9 +/- 1.3 vs. 13.4 +/- 0.3 mu mol.kg(-1).min(-1), P = 0.01). Fractional and absolute gluconeogene sis were increased in the patients (similar to 87 vs. similar to 59%, P < 0.001; and 14.6 +/- 1.3 vs. 7.9 +/- 0.2 mu mol.kg(-1).min(-1), P < 0.001, respectively). The contribution of glycogenolysis to total glu cose production was decreased in the patients: 2.3 +/- 0.5 vs. 5.5 +/- 0.4 mu mol.kg(-1).min(-1) (P < 0.002). In conclusion, in adult patien ts with uncomplicated falciparum malaria, glucose production is increa sed by similar to 25% due to an increased rate of gluconeogenesis, whe reas glycogenolysis is decreased. The mechanism by which these changes occur is uncertain. However, counterregulatory hormone and cytokine c oncentrations were increased in the patients.