Cerebral edema in DKA: Difference between revisions
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==Workup== | ==Workup== | ||
*Stat head CT (non-contrast) | |||
==Management<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>== | ==Management<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>== | ||
*Head of bed at 30 degrees | *Head of bed at 30 degrees | ||
*Mannitol 0.5-1gm/kg IV bolus over 20 minutes | *Mannitol 0.5-1gm/kg IV bolus over 20 minutes | ||
**Give a repeat does if there is an inadequate response | **Give a repeat does if there is an inadequate response | ||
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==Disposition== | ==Disposition== | ||
Admit ICU | Admit PICU/ICU | ||
==See Also== | ==See Also== | ||
Revision as of 22:58, 23 December 2014
Background
- 1% of patients with DKA[1]
- Almost all affected pts are <20yr [2]
- 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
- Seizure
- Acute Mental Status Change
- Signs of herniation
Differential Diagnosis
Workup
- 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
Sources
- Tintinalli 7th edition
- ↑ 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