Cerebral edema in DKA: Difference between revisions
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==Management== | ==Management== | ||
*Treatment should be performed in conjunction with primary team recommendations<ref>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.</ref> | *Treatment should be performed in conjunction with primary team recommendations<ref>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.</ref> | ||
*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 | |||
**If 2 doses of mannitol are ineffective, consider 3% saline 10mL/kg over 30min | |||
*Fluid restriction - decrease the IVF infusion rate by 30% | *Fluid restriction - decrease the IVF infusion rate by 30% | ||
*Noncardiogenic | *Noncardiogenic [[Pulmonary Edema]] | ||
==Disposition== | ==Disposition== | ||
Revision as of 08:13, 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
- 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
- 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
- Treatment should be performed in conjunction with primary team recommendations[2]
- 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
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.