Cerebral edema in DKA: Difference between revisions
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*Almost all affected pts are <20yr <ref>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.</ref> | *Almost all affected pts are <20yr <ref>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.</ref> | ||
*Associated with initial bicarb level; not rate of glucose drop | *Associated with initial bicarb level; not rate of glucose drop | ||
===Risk Factors=== | |||
#Age <5yo | |||
##Rare in >20yo | |||
#Severe hyperosmolality | |||
#Failure of Na to rise w/ therapy | |||
#Severe acidosis | |||
#Overaggressive fluid resuscitation is NOT a risk factor | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 9: | Line 17: | ||
*[[Mental Status Change]] / [[Seizure]] | *[[Mental Status Change]] / [[Seizure]] | ||
===Diagnosis=== | |||
*Begins 6-12hr after onset of therapy | |||
*Many appear to be improving from their DKA before deteriorating from cerebral edema | |||
*Premonitory symptoms: | |||
**HA, declining mental status, sz, respiratory arrest | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 19: | Line 32: | ||
*Noncardiogenic pulmonary edema | *Noncardiogenic pulmonary edema | ||
*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% | |||
==Disposition== | ==Disposition== | ||
Admit | Admit | ||
Revision as of 08:10, 29 April 2014
Background
- Almost all affected pts are <20yr [1]
- Associated with initial bicarb level; not rate of glucose drop
Risk Factors
- Age <5yo
- Rare in >20yo
- Severe hyperosmolality
- Failure of Na to rise w/ therapy
- Severe acidosis
- Overaggressive fluid resuscitation is NOT a risk factor
Clinical Features
- Symptoms:
- Headache
- Incontinence
- Mental Status Change / Seizure
Diagnosis
- Begins 6-12hr after onset of therapy
- Many appear to be improving from their DKA before deteriorating from cerebral edema
- Premonitory symptoms:
- HA, declining mental status, sz, respiratory arrest
Differential Diagnosis
Workup
Management
- Treatment should be performed in conjunction with primary team recommendations[2]
- Mannitol IV 1-2gm/kg OR
- 3% NS 5-10mL/kg over 30min
- Noncardiogenic pulmonary edema
- 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%
Disposition
Admit
See Also
Sources
- ↑ 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.
- ↑ Dunger DB, Sperling MA, Acerini CL, et al. (February 2004). "European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents". Pediatrics 113 (2): e133–40. doi:10.1542/peds.113.2.e133. PMID 14754983.