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Diabetic Ketoacidosis Related Cerebral Edema

Aka: Diabetic Ketoacidosis Related Cerebral Edema, DKA related Cerebral Edema
  1. See Also
    1. Diabetic Ketoacidosis
    2. Diabetic Ketoacidosis Management in Adults
    3. Diabetic Ketoacidosis Management in Children
  2. Epidemiology
    1. Incidence: 0.5 to 1% of Diabetic Ketoacidosis patients
  3. Risk Factors
    1. Younger children (<5 years old) with new onset of diabetes and longer duration of symptoms
    2. Severe acidosis
    3. Rapid hydration has been postulated as cause
      1. Precautions regarding fluid rate and amount are standard of care in Diabetic Ketoacidosis management (see below)
      2. However large study did not show an association with fluid rate or amount
      3. Glaser (2001) N Engl J Med 344(4): 264-9 [PubMed]
  4. Symptoms: Initial Symptoms
    1. Headache
    2. Refractory Vomiting
    3. Hypertension
    4. Bradycardia
    5. Lethargy
  5. Precautions: Children under age 5 years old with DKA
    1. Avoid large fluid boluses beyond initial 10-20 cc/kg if at all possible
    2. Avoid dropping Serum Osmolality (calc) >3 mOsms/hour
  6. Management
    1. See Diabetic Ketoacidosis Management in Adults
    2. See Diabetic Ketoacidosis Management in Children
  7. Prognosis
    1. Mortality: 21-24% (50% in some studies)
    2. Persistent vegatative state in up to one third of surviving children
  8. References
    1. Aurora and Menchine in Herbert (2014) EM:Rap 14(1): 10-11

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