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Cerebral edema in DKA
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(Redirected from Cerebral Edema in DKA)
Contents
Background
- 1% of patients with DKA[1]
- Almost all affected patients are <20yr [2]
- Associated with initial bicarb level; not rate of glucose drop
Risk Factors
- Age <5yo
- Severe hyperosmolality
- Failure of Na to rise with therapy
- Severe acidosis
- Overaggressive fluid resuscitation is NOT a risk factor
Clinical Features
- Begins 6-12hr after onset of therapy or may begin before initiation of treatment or up to 48h afterward
- Many appear to be improving from their DKA before deteriorating from cerebral edema
- Premonitory symptoms:
- Headache
- Incontinence
- Seizure
- Acute Mental Status Change
- Signs of herniation
Differential Diagnosis
Hyperglycemia
- Diabetic foot infection
- Diabetic ketoacidosis (DKA)
- Diabetic ketoacidosis (peds)
- Cerebral edema in DKA
- Hemochromatosis
- Hyperosmolar hyperglycemic state (HONC)
- Iron toxicity
- New onset diabetes mellitus
- Nonketotic hyperglycemia
- Sepsis
Evaluation
- Stat head CT (non-contrast)
Management[3]
- Head of bed at 30 degrees
- Mannitol 0.5-1gm/kg IV bolus over 20 minutes
- Give a repeat does if there is an inadequate response
- If 2 doses of mannitol are ineffective, consider 3% saline 10mL/kg over 30min
- Fluid restriction - decrease the IVF infusion rate by 30%
- Treat noncardiogenic pulmonary edema, if present
- Consult PICU and neurosurgery
Disposition
Admit PICU/ICU
See Also
References
- ↑ Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5
- ↑ Glaser NS, Wootton-Gorges SL, Buonocore MH, Marcin JP, Rewers A, Strain J, et al. Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr Diabetes. Apr 2006;7(2):75-80.
- ↑ Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5
