Barennes Hubert, Valea Innocent, Nagot Nicolas, Van de Perre Philippe, Pussard Eric
Centre Muraz, Bobo-Dioulasso, Burkina Faso, France.
Pediatrics. 2005 Nov;116(5):e648-53. doi: 10.1542/peds.2004-2218.
Hypoglycemia is a common determining factor of poor prognosis for children with severe malaria in sub-Saharan Africa. Intravenous dextrose administration is rarely available. Oral mucosal delivery may be an alternative to parenteral administration. A randomized, clinical trial was performed in Burkina Faso among moderately hypoglycemic children, comparing sublingual sugar administration with oral water, oral sugar, and dextrose infusion administrations.
Sixty-nine children with glucose concentrations of < 0.8 g/L were assigned randomly to 1 of 4 methods of administration, 1 with 3 different doses of sugar, as follows: oral group (OG) (n = 15): 2.5 g of sugar; sublingual group (SG) (n = 27): 2.5 g of sugar under the tongue, with 3 treatment subgroups, ie, 0.1 g/kg, 0.15 g/kg, and 0.2 g/kg; intravenous group (IG) (n = 8): 8 mL of 30% dextrose in a single bolus; water group (n = 11). Eight children received sublingual sugar twice, ie, 0.1 g/kg at baseline and 20 minutes later. Blood glucose concentrations were measured every 20 minutes for 80 minutes. Treatment failures, peak glucose concentrations, times to glucose concentration normalization, and kinetic profiles were evaluated.
No treatment failures were observed in the SG and IG, compared with 8 (53%) and 9 (81.8%) failures in the OG and water group, respectively. SG children exhibited glucose kinetic profiles and bioavailabilities (77%, 99%, and 81% in the 3 SG groups) similar to those of IG children. Bioavailabilities were 84% and 38% in the SG and OG, respectively. Children > 7 years of age required repeated sublingual administrations to maintain normoglycemia.
The sublingual administration of sugar proved to be effective among moderately hypoglycemic children. It is a simple and promising method to control hypoglycemia among children in both developing and developed countries. This pediatric practice should be investigated in more detail among children with severe malaria.
低血糖是撒哈拉以南非洲地区重症疟疾患儿预后不良的常见决定因素。静脉输注葡萄糖很少可行。口腔黏膜给药可能是胃肠外给药的一种替代方法。在布基纳法索对中度低血糖儿童进行了一项随机临床试验，比较舌下含服糖与口服水、口服糖及葡萄糖输注给药。
69名血糖浓度<0.8 g/L的儿童被随机分配至4种给药方法中的1种，其中1种有3种不同剂量的糖，如下：口服组（OG）（n = 15）：2.5 g糖；舌下组（SG）（n = 27）：2.5 g糖舌下含服，分为3个治疗亚组，即0.1 g/kg、0.15 g/kg和0.2 g/kg；静脉组（IG）（n = 8）：单次推注8 mL 30%葡萄糖；水组（n = 11）。8名儿童接受两次舌下含服糖，即基线时0.1 g/kg，20分钟后再次给药。每20分钟测量血糖浓度，共测量80分钟。评估治疗失败情况、血糖峰值浓度、血糖浓度恢复正常的时间及动力学曲线。
与OG组8例（53%）和水组9例（81.8%）治疗失败相比，SG组和IG组未观察到治疗失败。SG组儿童的葡萄糖动力学曲线和生物利用度（3个SG亚组分别为77%、99%和81%）与IG组儿童相似。SG组和OG组的生物利用度分别为84%和38%。7岁以上儿童需要重复舌下给药以维持血糖正常。
舌下含服糖在中度低血糖儿童中被证明是有效的。这是一种在发展中国家和发达国家控制儿童低血糖的简单且有前景的方法。对于重症疟疾患儿，应更详细地研究这种儿科实践。
