Hypoglycaemia in suppurative pancholanghtis due to Clonorchis Sinensis

Abstract

Over a period of 16 years, to the University Department of Medicine, Queen Mary Hospital, 11 patients were admitted deeply unconscious, with high fever and showing varying degrees of jaundice. In all the coma was associated with severe hypoglycaemia, and correction of this resulted in restoration of consciousness. The histories of the last 10 patients were remarkably similar. After 1–4 days of fever and right upper abdominal discomfort there were repeated rigors associated with distressing distending pain over the liver coupled with vomiting. All lost consciousness within 24 hours of the onset of rigors. The laboratory findings are briefly described. The findings at necropsy in 9 and at laparotomy in 2 were those of a diffuse suppurative pancholangiitis associated with obstruction tot he extrahepatic ducts by large numbers of dead Clonorchis sinensis. It is concluded that surgical removal of the plug of dead flukes and drainage of the biliary tree are essential in the management of the condition and that it should be carried out as early as possible. An investigation of the cause of the hypoglycaemia is described and it is concluded that it results from a hepatectomy-like effect. How the infection exerts this effect has not been determined. It is not due to necrosis of liver cells and is rapidly reversible through adequate treatment.