Hypoglycaemia in severe malaria — DTM&H MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: B — Capillary blood glucose
Explanation lettering: E = shown as A · C = shown as B · D = shown as C · A = shown as D · B = shown as E
C, capillary blood glucose, is correct because sweating and confusion with a falling temperature in a pregnant woman on quinine for severe falciparum malaria are classic features of quinine induced hyperinsulinaemic hypoglycaemia. Quinine stimulates pancreatic insulin release, and pregnancy itself increases the risk of severe malaria related hypoglycaemia. UK malaria treatment guidance specifically flags that patients treated with intravenous quinine require careful monitoring for hypoglycaemia, and that hypoglycaemia is particularly common in pregnancy. Confusion in this setting is far more likely to reflect a rapidly reversible metabolic cause than progression of cerebral malaria, so bedside capillary glucose is the immediate, cheap, fast investigation that must be done before anything else. Why the other options are wrong: A, Serum amylase: there is no clinical feature here suggesting pancreatitis (no abdominal pain), and amylase is not a rapid bedside test relevant to acute confusion in this context. B, Repeat stool microscopy: this addresses parasitaemia trend, not the acute neurological and autonomic change, and stool microscopy has no role in falciparum malaria monitoring since diagnosis and response are followed by blood films, not stool. D, Urinary eosinophils: this is used to investigate interstitial nephritis or eosinophiluria syndromes, entirely unrelated to sweating and confusion in treated malaria. E, D-dimer: raised D-dimer is nonspecific in severe malaria and would not explain or rapidly clarify sudden confusion with sweating; it does not change immediate management. Key point: sweating, confusion and falling temperature in a quinine treated pregnant patient with severe malaria should immediately trigger capillary blood glucose testing to exclude quinine induced hypoglycaemia.
Reference: UK Malaria Treatment Guidelines 2016 (PHE/UK Malaria Guidelines Writing Group, Journal of Infection 2016;72:635-649): Patients treated with intravenous quinine require careful monitoring for hypoglycaemia; hypoglycaemia is particularly common in severe malaria in pregnancy. https://www.journalofinfection.com/article/S0163-4453(16)00047-5/fulltext