Which of the following can cause hypoglycaemia in a patient of severe cerebral malaria on treatment?
Ans. a (Quinine). (Ref. Harrison, Internal Medicine, 17th ed. Table 203-7)QUININE# It is an erythrocytic schizonticide for all species of plasmodia# It is used with tetracycline in the treatment of complicated malaria and acute attack of F. malaria, but not useful to prevent recrudescence.# It causes slight lowering of blood sugar due to insulin release from pancreas and its rapid iv injection can cause hypoglycemia.# Should be used in pregnancy only for life-threatening malaria with special care to avoid hypoglycemia.Drug(s)Pharmacokinetic PropertiesAntimalarial ActivityMinor ToxicityMajor ToxicityQuinine, quinidineGood oral and IM absorption (quinine); CI and Vd reduced, but plasma protein binding (principally to ml acid glycoprotein) increased (90%) in malaria; quinine tl/2: 16 h in malaria, 11 h in healthy persons; quinidine tl/2: 13 h in malaria, 8 h in healthy personsActs mainly on trophozoite blood stage; kills gametocytes of P. vivax, P. ovale, and P. malariae (but not P. falciparum); no action on liver stages.Common: "Cinchonism": tinnitus, high- tone hearing loss, nausea, vomiting, dysphoria, postural hypotension;ECG QTc interval prolongation (quinine usually by <10% but quinidine by up to 25%)Rare:Diarrhea, visual disturbance, rashesNote:Very bitter tasteCommon:HypoglycemiaRare:Hypotension, blindness, deafness, cardiac arrhythmias, thrombo- cytopenia, hemolysis, hemolytic-uremic syndrome, vasculitis, cholestatic hepatitis, neuromuscular paralysisNote:Quinidine more cardiotoxic
Quinine
Chloroquine
Halofantrine
Mefloquine
Anti Microbial