INDICES> IM quinine injection versis IV infusion

[DID <did.jms@imul.com>]

INDICES> IM quinine injection versis IV infusion

Ladies and gentlemen,

IM quinine injection has caused problems to patients.  And in anaemic,
often  hypovolaemic, dehydrated patients, with severe malaria --
especially children, IM quinine injection is not appropriate.  I thought
by infusing with dextrose 5%, you do some rehydration, you correct
hypoglycaemia and attack the malaria parasites, all at the same time. 
Some very weak patients with severe malaria have gained some strength
with in minutes after a dextrose infusion.

An IM injection must be absorbed. My experience is that severe malaria
especially in kids is associated with dehydration and hypoglycaemia. 
Cause of death in severe malaria appears to be hypoglycaemia in
collaboration with anaemia.  We lost children because of lack of
blood--the quinine was given.  But a child still died.  Another was given
quinine immediately upon arrival at a health unit.  The boy was laughing,
but with very severe malaria.  A few hours later, the boy died.  The
state of the child did not reveal dehydration.  It appears hypoglycaemia
and other circulatory disorders caused the death.  We may need pin
pointing post portems in hospitals to guide proper management of future
cases?  Because plamodia per se may not be the immediate causers of
death.  But of course they are the initiators of pathological menace.

So, i thought if a copy of the St. Alberts mission hospital study in
Zimbabwe -- which concluded that IM quinine is similar to IV quinine is
sent to us, we would be happy.  Especially if it incorporated a component
of acceptability (3 traumas in the butt daily, until oral feasibility). 
Risk of abscesses and rate of recovery or the period of stay in the
hospital. 

Thank you again,

Sincerely,

George Kibumba, MPS(Uganda).

Drug Information Pharmacist
Drug Information Desk,
Joint Medical Store,
P.O.BOX 4501, KAMPALA, Uganda(E.A)
e-mail: did.jms@imul.com
Tel:    256-41-268482
fax:    256-41-267298
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