A 30-year-old woman presents with high-grade fever, severe headache, and altered sensorium. Blood smear shows P. falciparum rings. She has no history of quinine intake. Her blood glucose is 1.8 mmol/L. Which of the following CORRECTLY explains the mechanism of hypoglycemia in this case?

• A Decreased gluconeogenesis due to impaired hepatic glycogenolysis by malaria toxins
• B Insulin-like effect of quinine stimulating pancreatic beta cells
• C Renal tubular loss of glucose due to falciparum-induced nephropathy
• D Increased glucose consumption by the large parasite biomass and cytokine-mediated glycogenolysis inhibition ✓

Explanation

In severe falciparum malaria without quinine exposure, hypoglycemia occurs due to: (1) high metabolic demand and glucose consumption by the massive parasite burden, and (2) TNF-α and other cytokines impairing gluconeogenesis and promoting anaerobic glycolysis in the host. The quinine-mediated mechanism (hyperinsulinism) is distinct and applies when quinine/quinidine is administered. Renal glycosuria is not a significant mechanism in falciparum malaria.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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