Pediatric diabetic ketoacidosis and cerebral oedema: a systematic review
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Diabetic ketoacidosis (DKA) is present in about 30% of pediatric patients diagnosed with new-onset type 1 diabetes. Among such patients, cerebral oedema is relatively uncommon (<1%), representing about 0.1%–0.3% of deaths. However, 25% of these survivors of cerebral oedema suffer permanent neurologic deficits. Clinical presentation may be nonspecific, but the laboratory parameters of hyperglycaemia and ketosis are present in almost all cases, and treatment mainstay depends on intravenous fluids and insulin. The pathophysiology of cerebral oedema and related injury to the brain cells is not fully understood. Different modalities have been used to manage cerebral oedema related to DKA. Here we will review such targeted management options to allow immediate treatment regardless of cause. Such techniques could include fluid restriction, ABC, neuroprotective measures, and osmotherapy with mannitol and/or hypertonic saline.
Abstract
Diabetic ketoacidosis (DKA) is present in about 30% of pediatric patients diagnosed with new-onset type 1 diabetes. Among such patients, cerebral oedema is relatively uncommon (<1%), representing about 0.1%–0.3% of deaths. However, 25% of these survivors of cerebral oedema suffer permanent neurologic deficits. Clinical presentation may be nonspecific, but the laboratory parameters of hyperglycaemia and ketosis are present in almost all cases, and treatment mainstay depends on intravenous fluids and insulin. The pathophysiology of cerebral oedema and related injury to the brain cells is not fully understood. Different modalities have been used to manage cerebral oedema related to DKA. Here we will review such targeted management options to allow immediate treatment regardless of cause. Such techniques could include fluid restriction, ABC, neuroprotective measures, and osmotherapy with mannitol and/or hypertonic saline.