GLUCOSE-HOMEOSTASIS IN CHILDREN WITH FALCIPARUM-MALARIA - PRECURSOR SUPPLY LIMITS GLUCONEOGENESIS AND GLUCOSE-PRODUCTION

To evaluate glucose kinetics in children with falciparum malaria, basa l glucose production and gluconeogenesis and an estimate of the flux o f the gluconeogenic precursors were measured in Kenyan children with u ncomplicated falciparum malaria before (n = 11) and during infusion of alanine (1.5 mg/kg.min; n = 6). Glucose production was measured by [6 ,6-H-2(2)]glucose, gluconeogenesis by mass isotopomer distribution ana lysis of glucose labeled by [2-C-13]glycerol. Basal plasma glucose con centration ranged from 2.1-5.5 mmol/L, and basal glucose production ra nged from 3.3-7.3 mg/kg.min. Glucose production was largely derived fr om gluconeogenesis (73 +/- 4%; range, 52-93%). During alanine infusion , plasma glucose increased by 0.4 mmol/L (P = 0.03), glucose productio n increased by 0.8 mg/kg.min (P = 0.02), and gluconeogenesis increased by 0.8 mg/kg.min (P = 0.04). We conclude that glucose production in c hildren with uncomplicated falciparum malaria is largely dependent on gluconeogenesis. However, gluconeogenesis is potentially limited by in sufficient precursor supply. These data indicate that in children with falciparum malaria, gluconeogenesis fails to compensate in the presen ce of decreased glycogen flux to glucose, increasing the risk of hypog lycemia.