<prompt> Which of the following can cause hypoglycaemia in a patient of severe cerebral malaria on treatment?QuinineChloroquineHalofantrineMefloquine  <response>: Ans. a Quinine. Ref. Harrison, Internal Medicine, 17th ed. Table 203-7QUININE It is an erythrocytic schizonticide for all species of plasmodia It is used with tetracycline in the treatment of complicated malaria and acute attack of F. malaria, but not useful to prevent recrudescence. It causes slight lowering of blood sugar due to insulin release from pancreas and its rapid iv injection can cause hypoglycemia. Should be used in pregnancy only for life-threatening malaria with special care to avoid hypoglycemia.DrugsPharmacokinetic PropertiesAntimalarial ActivityMinor ToxicityMajor ToxicityQuinine, quinidineGood oral and IM absorption quinine; CI and Vd reduced, but plasma protein binding principally to ml acid glycoprotein increased 90 in malaria; quinine tl2: 16 h in malaria, 11 h in healthy persons; quinidine tl2: 13 h in malaria, 8 h in healthy personsActs mainly on trophozoite blood stage; kills gametocytes of P. vivax, P. ovale, and P. malariae but not P. falciparum; no action on liver stages.Common: Cinchonism: tinnitus, high- tone hearing loss, nausea, vomiting, dysphoria, postural hypotension;ECG QTc interval prolongation quinine usually by 10 but quinidine by up to 25Rare:Diarrhea, visual disturbance, rashesNote:Very bitter tasteCommon:HypoglycemiaRare:Hypotension, blindness, deafness, cardiac arrhythmias, thrombo- cytopenia, hemolysis, hemolytic-uremic syndrome, vasculitis, cholestatic hepatitis, neuromuscular paralysisNote:Quinidine more cardiotoxic 