Cerebral Edema in Diabetic Ketoacidosis
Mary Perry Alexander
Takara Stanley
Risk Factors for Cerebral Edema in Children With Diabetic Ketoacidosis
Glaser NG, Barnett IM, McCaslin I, et al. N Engl J Med. 2001;344(4):264ā269
Background
Cerebral edema is a dreaded complication of diabetic ketoacidosis (DKA) and the most common cause of DKA-related mortality. Prior to this study, only a few small clinical studies had elucidated risk factors for cerebral edema in children presenting with DKA: younger age, new diabetes diagnosis, and faster fluid resuscitation rates. The potential effect of other factors, particularly therapeutic interventions, had yet to be assessed in large cohorts.
Objectives
To identify the risk factors associated with development of cerebral edema among children presenting with DKA.
Methods
Retrospective, case-controlled study at 10 US pediatric centers from 1982 to 1997.
Patients
416 patients ā¤18 years old with DKA (serum glucose >300 mg/dL, venous pH <7.25 or serum bicarbonate <15 mmol/L, and ketonuria). This included 61 cases with cerebral edema, 174 matched controls without cerebral edema, and 181 random controls without cerebral edema.
Intervention
Comparison of demographic characteristics, initial biochemical values, treatment regimen, and changes in laboratory values during treatment between the groups.
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