Cerebrovascular complications of diabetic ketoacidosis in children

Siqueira, Luis Felipe Mendonça de

doi:10.1590/s0004-27302011000400009

Cited by 12 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cerebral edema was diagnosed when there was low Glasgow coma scale (GCS) (<13) accompanied by one or more other signs of raised intracranial pressure (hypertension and bradycardia with or without breathing pattern abnormalities, pupillary abnormalities, squint, blurred disk margin, decerebrate or decorticate posturing, respiratory arrest or radiological evidence of moderate to severe edema on computed tomography). 5 Stroke was diagnosed if there was evidence of focal neurological deficit and radiological evidence of cerebral infarction. 5 Shock was defined as tachycardia with capillary refill time > 3 seconds and cold peripheries with or without hypotension as per pediatric advanced life support (PALS) guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…Because of its high morbidity and mortality, cerebral edema has been the main focus of research in DKA patient. 5 But DKA has been described in literature to be associated with many other complications including DKA associated cerebral injury, electrolyte imbalance, vascular, renal, cardiopulmonary and other complications. 4 Reports on isolated complications of DKA have been published in literature.…”

Section: Introductionmentioning

confidence: 99%

“… 4 Reports on isolated complications of DKA have been published in literature. 5 - 7 But there is a dearth of literature on all complications of DKA in children which can lead to greater morbidity and prolonged length of stay. 6 , 8 We describe our experience of complications of severe DKA observed in our pediatric intensive care unit (PICU).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit

Abbas¹,

Arbab²,

Haque³

et al. 2018

Pak J Med Sci

View full text Add to dashboard Cite

Objectives:To describe the spectrum of complications of Diabetic Ketoacidosis (DKA) observed in children admitted with severe DKA.Methods:Retrospective review of the medical records of all children admitted with the diagnosis of severe DKA in Pediatric Intensive Care Unit (PICU) of the Aga Khan University Hospital, from January 2010 to December 2015 was done. Data was collected on a structured proforma and descriptive statistics were applied.Results:Total 37 children were admitted with complicated DKA (1.9% of total PICU admission with 1.8% in 2010 and 3.4% in 2015). Mean age of study population was 8.1±4.6 years and 70% were females (26/37). Mean Prism III score was 9.4±6, mean GCS on presentation was 11±3.8 and mean lowest pH was 7.00±0.15. Complications observed included hyperchloremia (35.94%), hypokalemia (30.81%), hyponatremia (26.70%), cerebral edema (16.43%), shock (13.35%), acute kidney injury (10.27%), arrhythmias (3.8%), and thrombotic thrombocytopenic purpura (5.4%), while one patient had myocarditis and ARDS each. 13/37 children (35%) needed inotropic support, 11/37 (30%) required mechanical ventilation while only one patient required renal replacement therapy. Two patients (5.4%) died during their PICU stay.Conclusion:Hyperchloremia and other electrolyte abnormalities, cerebral edema and AKI are the most common complications of severe DKA.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit

Abbas¹,

Arbab²,

Haque³

et al. 2018

Pak J Med Sci

View full text Add to dashboard Cite

show abstract

“…Recent studies using MRI measures show altered brain structure and injury associated with adverse neurocognitive outcomes, including impairment in neuronal function and viability in T1D children [69, 70]. Patients with DKA have been reported to have prothrombotic tendencies due to their higher propensity to develop clots [4, 71]. Cerebral edema, hemorrhagic stroke, or acute ischemia associated with hyperketonemia has been implicated to intracerebral complications and neurological deterioration [72, 73].…”

Section: Dka Oxidative Stress and Diabetic Co-morbiditiesmentioning

confidence: 99%

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

Marie

Jain

2016

Free Radical Biology and Medicine

128

108

View full text Add to dashboard Cite

Diets that boost ketone production are increasingly used for treating several neurological disorders. Elevation in ketones in most cases is considered favorable, as they provide energy and are efficient in fueling the body’s energy needs. Despite all the benefits from ketones, the above normal elevation in the concentration of ketones in the circulation tend to illicit various pathological complications by activating injurious pathways leading to cellular damage. Recent literature demonstrates a plausible link between elevated levels of circulating ketones and oxidative stress, linking hyperketonemia to innumerable morbid conditions. Ketone bodies are produced by the oxidation of fatty acids in the liver as a source of alternative energy that generally occurs in glucose limiting conditions. Regulation of ketogenesis and ketolysis plays an important role in dictating ketone concentrations in the blood. Hyperketonemia is a condition with elevated blood levels of acetoacetate (AA), 3-β-hydroxybutyrate (BHB), and acetone. Several physiological and pathological triggers, such as fasting, ketogenic diet, and diabetes cause an accumulation and elevation of circulating ketones. Complications of the brain, kidney, liver, and microvasculature were found to be elevated in diabetic patients who had elevated ketones compared to those diabetics with normal ketone levels. This review summarizes the mechanisms by which hyperketonemia and ketoacidosis cause an increase in redox imbalance and thereby increasing the risk of morbidity and mortality in patients.

show abstract

“…Laiku diagnozavus ir gydant CD, galima kontroliuoti kraujagyslių aterosklerozinius pokyčius ir išvengti išeminio insulto [29]. Nagrinėjamos diabetinės ketoacidozės neurologinės komplikacijos vaikams: diabetinė ketoacidozė gali komplikuotis galvos smegenų edema ir išeminiu insultu [30]. Insulto diagnostika sergant CD yra sudėtinga.…”

Section: Rezultatų Aptarimasunclassified

Neurologinė Patologija Sergant 2 Tipo Cukriniu Diabetu

Kimševaitė¹

2017

Medicinos Teorija Ir Praktika

View full text Add to dashboard Cite

Vilniaus miesto klinikinė ligoninė Vilnius City Clinical Hospital SANTRAUKAReikšminiai žodžiai: cukrinis diabetas, neurologinė patologija, neurologinės komplikacijos. Darbo tikslas. Išanalizuoti 2 tipo cukriniu diabetu sergančių asmenų neurologinę patologiją. Tyrimo medžiaga ir metodai. Vilniaus miesto klinikinės ligoninės Vidaus ligų, Nefrologijos, I ir II angiochirurgijos, Urologijos skyriuose 2015 m. rugpjūtį -2016 m. birželį tyrėme 102 2 tipo cukriniu diabetu sergančius ligonius (80 moterų ir 22 vyrus), kuriems buvo ar pasireiškė neurologinė patologija. Ligonių amžius 49-92 metai (vidurkis 73,2 ± 1,1 metų). Visiems ligoniams atliktas bendras kraujo tyrimas, nustatyta gliukozės koncentracija kraujo serume, glikozilintas hemoglobinas HbA1C, atlikta vidaus organų echoskopija, daliai ligonių -pilvo organų kompiuterinė tomografija (KT), esant indikacijoms -galvos (stuburo) KT, magnetinio rezonanso tomografija (MRT). Statistinių duomenų vidurkių skirtumai vertinti Stjudento patikimumo kriterijumi t. Skirtumai laikyti statistiškai patikimi esant p < 0,05. Rezultatai. Išanalizuota sergančiųjų 2 tipo cukriniu diabetu neurologinė patologija. Galvos smegenų kraujotakos sutrikimai buvo 23 (22,5 proc.) ligoniams, diabetinė encefalopatija -4 (3,9 proc.), diabetinė koma -1 (1 proc.), hipoglikeminė koma -1 (1 proc.), lėtinė galvos smegenų išemija -10 (9,8 proc.), epilepsiniai priepuoliai -3 (2,9 proc.), Parkinsono liga -3 (2,9 proc.), diabetinė chorėja -1 (1 proc.), diabetinė mielopatija -1 (1 proc.), diabetinė periferinė neuropatija -46 (45,1 proc.), diabetinė autonominė neuropatija -3(2,9 proc.), peties rezginio neuropatija (plexopathia brachialis) -1 (1 proc.), veidinio nervo neuropatija -2 (2 proc.), vidurinio nervo neuropatija -1 (1 proc.), meralgia paraesthetica -2 (2 proc.). Galvos smegenų infarkto atveju, palyginus su sergančiųjų lėtine galvos smegenų išemija grupe, nustatyta statistiškai patikimai didesnė hiperglikemija: ženkliai padidėjęs gliukozės (11,08 ± 1,3 mmol/l, p < 0,02), glikozilinto hemoglobino HbA1C (8,5 ± 1,2 proc., p < 0,05) kiekis kraujyje. Lėtine galvos smegenų išemija sergančiųjų grupėje gliukozės kiekis kraujyje buvo 7,26 ± 0,4 mmol/l, glikozilinto hemoglobino HbA1C -6,03 ± 0,2 proc. Padidėjęs gliukozės, glikozilinto hemoglobino HbA1C kiekis kraujyje, palyginus su sergančiųjų lėtine galvos smegenų išemija grupe, nustatytas ir praeityje galvos smegenų infarktą patyrusiems ligoniams -atitinkamai 8,65 ± 0,7 mmol/l ir 7,26 ± 0,4 mmol/l (p > 0,05), 7,2 ± 0,4 proc. ir 6,03 ± 0,2 proc. (p < 0,01). Nustatyta sergančiųjų diabetine polineuropatija hiperglikemijos dydžio priklausomybė nuo cukrinio diabeto trukmės: sergančiųjų cukriniu diabetu daugiau kaip 10 metų, palyginus su sergančiųjų iki 5 metų grupe, gliukozės kiekis kraujyje buvo atitinkamai 9,93 ± 0,8 mmol/l ir 7,6 ± 0,7 mmol/l (p < 0,05), glikozilinto hemoglobino HbA1C -8,2 ± 0,3 proc. ir 5,78 ± 0,1 proc. (p < 0,001). Sergančiųjų cukriniu diabetu nuo 5 iki 10 metų gliukozės kiekis kraujyje buvo 8,3 ± 1,0 mmol/l, (p > 0,05), glikozilinto hemoglobino ...

show abstract

Cerebrovascular complications of diabetic ketoacidosis in children

Cited by 12 publications

References 11 publications

Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit

Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

Neurologinė Patologija Sergant 2 Tipo Cukriniu Diabetu

Contact Info

Product

Resources

About