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O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

All these years I used to criticise G. Ps for admitting patients of common fever to administer IV glucose in the nursing homes.

I would still not recommend any IV glucose in patients who can take liquids by mouth (because of the side effects - rigors because of contaminants or even anaphylactic type of reactions). But I have second thoughts that GPs may be doing the right thing!! This reasoning is based on the following facts which have been brought out during the last few years:-
    1. In patients suffering from severe falciparum malaria, which is a killer, mortality and morbidity is often due to severe hypoglycaemia, the cause of which is still not clear. This hypoglycaemia could be very severe and recurrent so that only IV glucose drip can look after such patients.
    2. Viral Hepatitis - Patients having viral hepatitis who are very toxic and who are going into hepatic coma often develop severe hypoglycaemia. Again the reason for this is not clear. It could be recurrent and could lead to severe morbidity and mortality. No amount of glucose by mouth can raise the blood sugar of such patients. Only IV glucose would work.
    3. Typhoid patients who have not been eating for a very long time can develop a slightly low blood sugar. Although, according to me no amount of fasting can lower the blood sugar in a patient having normal liver metabolism, it appears to me that IV glucose can "reduce" the toxicity of a typhoid patient.
In the three above common fevers, thus giving IV glucose can be justified, but it should be understood that such patients cannot be treated in small nursing homes and will certainly need hospitalisation and that too possibly in an ICU. This is because of the other associated complications which can occur in such patients. Hundreds of routine patients of vivax malaria or viral hepatitis or typhoid certainly need no glucose.

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