Cerebral edema in DKA: Difference between revisions
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Revision as of 00:38, 19 September 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
- Tintinalli 7th edition
- ↑ 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.