Diabetic Ketoacidosis Related Cerebral Edema

Sep 16, 2019 admin NỘI TIẾT, TIM MẠCH 0

Diabetic Ketoacidosis Related Cerebral Edema

Aka: Diabetic Ketoacidosis Related Cerebral Edema, DKA related Cerebral Edema

II. Epidemiology

  1. Incidence: 0.5 to 1% of Diabetic Ketoacidosis patients

III. 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]

IV. Symptoms: Initial Symptoms

  1. Headache
  2. Refractory Vomiting
  3. Hypertension
  4. Bradycardia
  5. Lethargy

V. 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

VI. Management

  1. See Diabetic Ketoacidosis Management in Adults
  2. See Diabetic Ketoacidosis Management in Children

VII. Prognosis

  1. Mortality: 21-24% (50% in some studies)
  2. Persistent vegatative state in up to one third of surviving children

VIII. References

  1. Aurora and Menchine in Herbert (2014) EM:Rap 14(1): 10-11

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