Cerebral edema in DKA: Difference between revisions
Kghaffarian (talk | contribs) No edit summary |
|||
| Line 11: | Line 11: | ||
==Clinical Features== | ==Clinical Features== | ||
*Begins 6-12hr after onset of therapy | *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 | **Many appear to be improving from their DKA before deteriorating from cerebral edema | ||
*Premonitory symptoms: | *Premonitory symptoms: | ||
| Line 37: | Line 37: | ||
==Sources== | ==Sources== | ||
<references/> | <references/> | ||
Tintinalli 7th edition | |||
Revision as of 17:18, 28 July 2014
Background
- Almost all affected pts are <20yr [1]
- Associated with initial bicarb level; not rate of glucose drop
Risk Factors
- Age <5yo
- Severe hyperosmolality
- Failure of Na to rise w/ 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
- Mental Status Change / Seizure
Differential Diagnosis
Workup
Management
- 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%
- Noncardiogenic Pulmonary Edema
Disposition
Admit ICU
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.
Tintinalli 7th edition