Title: Complications of Malaria Treatment in the Pediatric Population
 题目：治疗儿科疟疾病人的并发症
Author 作者: Andrea Tenner

Case Presentation 病例介绍:
You are working in an ED in Houston when a 2 year old girl presents with fever for one day and decreased po intake.  On arrival her temp=103, HR=180, and RR=50 SaO2=100%.  She was born in the US and is up to date on all of her vaccinations, but has just returned from a trip to Liberia where she was visiting her extended family and received multiple mosquito bites.  Physical exam, CXR and urinalysis are otherwise unremarkable and you suspect malaria, based on her history.  You start quinine IV while you are waiting for the smear when suddenly the child becomes unresponsive.
当你在休斯敦的一个急诊科工作时，一个2岁的女孩因发烧一天，摄入减少就诊。当时她的温度= 103， HR = 180 ， RR = 50，血氧饱和度= 100％。她出生在美国，迄今为止已完成所有的疫苗接种。病人刚从访问利比里亚回来，在那里访问其它几个远房亲戚时被蚊虫叮咬多次。体检，胸部X光检查和尿检均正常。根据她的病史，你怀疑是疟疾。在等待涂抹片时，你开始静脉给奎宁，但发现孩子突然变得反应迟钝。
Clinical Question 临床问题:
What is the next investigation you should perform?
 下一步你应该做什么？
Answer 答案 :
Rapid blood glucose!
快速测血糖！
This patient has at least 4 reasons to be hypoglycemic:
这个患者血糖低有至少有4个原因：
1. fasting (Kids can become hypoglycemic from fasting alone in ~24hrs)
1。空腹（孩子们可以在禁食24小时内发生低血糖）
2. infection (any infectious disease can cause it, esp in kids <3 yrs old)
2。感染（任何传染病都可引起低血糖，尤其在3岁以内）
3. malaria (thought to be due in part to increased consumption by parasite)
3。疟疾（被认为部分原因是由于寄生虫消耗增加）
4. quinine (stimulates insulin release)
4 奎宁（刺激胰岛素释放）
Bottom Line 要点:
Kids can become hypoglycemic fast—check a blood glucose in all pre-pubertal sick children.
孩子可以很快出现低血糖，对所有青春期前患重病的儿童要检查血糖。
References 参考文献：

Zijlmans WCWR et al.  Glucose metabolism in children: influence of age, fasting, and infectious diseases.  Metabolism Clinical and Experimental.  2009.  58:1356-1365.