Cerebral edema in DKA
- Almost all affected pts are <20yr 
- Associated with initial bicarb level; not rate of glucose drop
- Age <5yo
- Rare in >20yo
- Severe hyperosmolality
- Failure of Na to rise w/ therapy
- Severe acidosis
- Overaggressive fluid resuscitation is NOT a risk factor
- Begins 6-12hr after onset of therapy
- Many appear to be improving from their DKA before deteriorating from cerebral edema
- Premonitory symptoms:
- HA, declining mental status, sz, respiratory arrest
- Treatment should be performed in conjunction with primary team recommendations
- Mannitol IV 1-2gm/kg OR
- 3% NS 5-10mL/kg over 30min
- Noncardiogenic pulmonary edema
- 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%
- 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.