Sublingual sugar for hypoglycaemia in children with severe malaria: A pilot clinical study

29.11.2008

Provisional pdf available at :

and

http://www.malariajournal.com/content/7/1/242

Published in

Malaria Journal 2008, 7:242 doi:10.1186/1475-2875-7-242

Abstract

Background

Hypoglycaemia is a poor prognostic indicator in severe malaria. Intravenous infusions

are rarely feasible in rural areas. The efficacy of sublingual sugar (SLS) was assessed

in a pilot randomized controlled trial among hypoglycaemic children with severe

malaria in Mali.

Methods

Of 151 patients with presumed severe malaria, 23 children with blood glucose

concentrations <60 mg/dl (<3.3mmol/l) were assigned randomly to receive either

intravenous 10% glucose (IVG; n=9) or sublingual sugar (SLS; n=14). In SLS, a

teaspoon of sugar, moistened with a few drops of water, was gently placed under the

tongue every 20 minutes. The child was put in the recovery position. Blood glucose

concentration (BGC) was measured every 5-10 minutes for the first hour. All children

were treated for malaria with intramuscular artemether. The primary outcome

measure was treatment response, defined as reaching a BGC of >= 3.3mmol/l

(60mg/dl) within 40 minutes after admission. Secondary outcome measures were

early treatment response at 20 minutes, relapse (early and late), maximal BGC gain

(CGmax), and treatment delay.

Results

There was no significant difference between the groups in the primary outcome

measure. Treatment response occurred in 71% and 67% for SLS and IVG,

respectively. Among the responders, relapses occurred in 30% on SLS at 40 minutes

and in 17% on IVG at 20 minutes. There was one fatality in each group. Treatment

failures in the SLS group were related to children with clenched teeth or swallowing

the sugar, whereas in the IVG group, they were due to unavoidable delays in

beginning an infusion (median time 17.5 min (range 3-40).

Among SLS, the BGC increase was rapid among the nine patients who really kept the

sugar sublingually. All but one increased their BGC by 10 minutes with a mean gain

of 44 mg/dl (95%CI: 20.5-63.4).

Conclusions

Sublingual sugar appears to be a child-friendly, well-tolerated and effective promising

method of raising blood glucose in severely ill children. More frequent repeated doses

are needed to prevent relapse. Children should be monitored for early swallowing

which leads to delayed absorption, and in this case another dose of sugar should be

given. Sublingual sugar could be proposed as an immediate “first aid” measure while

awaiting intravenous glucose. In many cases it may avert the need for intravenous

glucose.