Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. e648-e653 (doi:10.1542/peds.2004-2218)
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Malaria

ELECTRONIC ARTICLE

Sublingual Sugar Administration as an Alternative to Intravenous Dextrose Administration to Correct Hypoglycemia Among Children in the Tropics

Hubert Barennes, MD, MPH, PhD*, Innocent Valea, MPH*, Nicolas Nagot, MD, MPH*, Philippe Van de Perre, MD, PhD*,{ddagger} and Eric Pussard, PhD§

* Centre Muraz, Bobo-Dioulasso, Burkina Faso
{ddagger} Montpellier University Hospital Arnaud de Villeneuve, Laboratory of Bacteriology-Virology, and University of Montpellier 1, Montpellier, France
§ Hôpital Kremlin Bicêtre, Pharmacology Unit, Paris, France

Background. 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.

Methods. 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.

Results. 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.

Conclusions. 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.

Key Words: hypoglycemia • tropics • sublingual • malaria

Abbreviations: OG, oral group • SG, sublingual group • IG, intravenous group • WG, water group • Cmax, blood glucose concentration gain • AUC, area under the concentration-time curve

Accepted May 12, 2005.




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Sublingual Sucrose: Wrong Sugar ? !
Harry W. Gedney
Pediatrics Online, 25 May 2007 [Full text]