Cerebral edema in DKA: Difference between revisions
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==Background== | ==Background== | ||
*1% of patients with DKA<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref> | |||
*[[Cerebral edema in DKA|Cerebral edema]] | |||
*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 | ||
Revision as of 22:56, 23 December 2014
Background
- 1% of patients with DKA[1]
- Cerebral edema
- 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
- Acute Mental Status Change / Seizure
- Signs of herniation
Differential Diagnosis
Workup
Management[3]
- Head of bed at 30 degrees
- Stat head CT (non-contrast)
- 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 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