Quinine-Induced Hypoglycemia
Authors: P. J. Limburg, H. Katz, C. S. Grant
Journal: Annals of Internal Medicine (1993)

Brief Reports1 August 1993Quinine-Induced HypoglycemiaP. J. Limburg, MD, H. Katz, MD, C. S. Grant, MD, and F. J. Service, MDP. J. Limburg, MDFrom the Mayo Clinic and Mayo Medical School, Rochester, Minnesota.Search for more papers by this author, H. Katz, MDFrom the Mayo Clinic and Mayo Medical School, Rochester, Minnesota.Search for more papers by this author, C. S. Grant, MDFrom the Mayo Clinic and Mayo Medical School, Rochester, Minnesota.Search for more papers by this author, and F. J. Service, MDFrom the Mayo Clinic and Mayo Medical School, Rochester, Minnesota.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-3-199308010-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Table. SI Units and Drug Although quinine has been repeatedly implicated in the genesis of hypoglycemia observed in severe falciparum malaria [1-4], no well-documented cases of quinine-mediated hypoglycemia have been reported in healthy persons. We describe a patient who had repeated episodes of symptomatic hypoglycemia during quinine therapy for leg cramps.Case ReportA 66-year-old white man had a 2.5-year history of episodic intense diaphoresis, tremulousness, and weakness without confusion or unconsciousness, relieved within 10 minutes of eating a candy bar. Episodes occurred just before or about 2 hours after meals. Because of a fasting ...References1. White NJ, Warrell DA, Chanthavanich P, Looareesuwan S, Warrell MJ, Krishna S, et al. Severe hypoglycemia and hyperinsulinemia in falciparum malaria. N Engl J Med. 1983; 309:61-6. Google Scholar2. Okitolonda W, Delacollette C, Malengreau M, Henquin JC. High incidence of hypoglycaemia in African patients treated with intravenous quinine for severe malaria. Br Med J. (Clin Res Ed). 1987; 295:716-8. Google Scholar3. Arya TV, Prasad RN, Bhandari S, Awasthi R. Spontaneous and quinine induced hypoglycaemia in severe falciparum malaria. Trop Geogr Med. 1989; 41:73-5. Google Scholar4. Das BS, Satpathy SK, Mohanty D, Mohanty S, Mishra SK, Satapathy PC, et al. Hypoglycaemia in severe falciparum malaria. Trans R Soc Trop Med Hyg. 1988; 82:197-201. Google Scholar5. Kadish AH, Litle RL, Sternberg JC. A new and rapid method for the determination of glucose by measurement of rate of oxygen consumption. Clin Chem. 1968; 14:116. Google Scholar6. Service FJ, O'Brien PC, Kao PC, Young WF Jr. C-peptide suppression test: effects of gender, age, and body mass index; implications for the diagnosis of insulinoma. J Clin Endocrinol Metab. 1992; 74: 204-10. Google Scholar7. Harats N, Ackerman Z, Shalit M. Quinine-related hypoglycemia (Letter). N Engl J Med. 1984; 310:1331. Google Scholar8. Jones RG, Sue-Ling HM, Kear C, Wiles PG, Quirke P. Severe symptomatic hypoglycaemia due to quinine therapy. J R Soc Med. 1986; 79:426-8. Google Scholar9. Henquin JC, Horemans B, Nenquin M, Verniers J, Lambert AE. Quinine-induced modifications of insulin release and glucose metabolism by isolated pancreatic islets. FEBS Lett. 1975; 57:280-4. Google Scholar10. Service FJ, O'Brien PC, McMahon MM, Kao PC. C-peptide during the prolonged fast in insulinoma. J Clin Endocrinol Metab. 1993; 76: 655-9. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the Mayo Clinic and Mayo Medical School, Rochester, Minnesota.Corresponding Author: F. John Service, MD, Division of Endocrinology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. 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