Phillips R E, Looareesuwan S, White N J, Chanthavanich P, Karbwang J, Supanaranond W, Turner R C, Warrell D A
Br Med J (Clin Res Ed). 1986 May 17;292(6531):1319-21. doi: 10.1136/bmj.292.6531.1319.
Life threatening hypoglycaemia has been closely associated with the use of quinine, but the effect of quinidine and the synthetic antimalarials on the homoeostasis of glucose has not been investigated. In volunteers given a fixed dose of 500 mg base and patients with malaria given a quinidine loading dose (15 mg base/kg) mean (SEM) plasma insulin concentrations rose from 6.1 (1.5) mU/l to 10.9 (4.4) mU/l (p less than 0.02) and 10.4 (2.0) mU/l to 18.5 (5.3) mU/l (p less than 0.04), respectively. Plasma glucose concentrations fell from 4.5 (1.1) mmol/l (81 (20) mg/100 ml) to 4.0 (0.3) mmol/l (72 (5) mg/100 ml) in volunteers (p less than 0.04) and from 5.7 (1.3) mmol/l (102 (23) mg/100 ml) to 4.8 (1.6) mmol/l (86 (29) mg/100 ml) in patients (p less than 0.05). One of two patients with cerebral malaria and acute renal failure became profoundly hypoglycaemic (plasma glucose concentration 1.4 mmol/l (25 mg/100 ml), plasma insulin concentration 3.1 mU/l). Hypoglycaemia may occur in any severely ill fasting patient given parenteral quinidine. The other antimalarials tested, chloroquine, amodiaquine, mefloquine, and halofantrine, did not stimulate the release of insulin, an important advantage that should be taken into account when treatment is chosen for Plasmodium falciparum malaria.
危及生命的低血糖症与奎宁的使用密切相关，但奎尼丁和合成抗疟药对葡萄糖稳态的影响尚未得到研究。在给予500mg碱基固定剂量的志愿者以及给予奎尼丁负荷剂量（15mg碱基/千克）的疟疾患者中，平均（标准误）血浆胰岛素浓度分别从6.1（1.5）mU/L升至10.9（4.4）mU/L（p<0.02）和从10.4（2.0）mU/L升至18.5（5.3）mU/L（p<0.04）。志愿者的血浆葡萄糖浓度从4.5（1.1）mmol/L（81（20）mg/100ml）降至4.0（0.3）mmol/L（72（5）mg/100ml）（p<0.04），患者的血浆葡萄糖浓度从5.7（1.3）mmol/L（102（23）mg/100ml）降至4.8（1.6）mmol/L（86（29）mg/100ml）（p<0.05）。两名患有脑型疟疾和急性肾衰竭的患者中有一人出现严重低血糖（血浆葡萄糖浓度1.4mmol/L（25mg/100ml），血浆胰岛素浓度3.1mU/L）。任何接受胃肠外奎尼丁治疗的重症禁食患者都可能发生低血糖。所测试的其他抗疟药，氯喹、阿莫地喹、甲氟喹和卤泛群，均未刺激胰岛素释放，这是在选择治疗恶性疟原虫疟疾时应考虑的一个重要优势。
