Cerebral Oedema Complicating Diabetic Ketoacidosis

Greene, S A; Jefferson, I G; Baum, J D

doi:10.1111/j.1469-8749.1990.tb08548.x

Cited by 16 publications

(1 citation statement)

References 23 publications

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“…While major treatment errors in fluid, electrolyte or insulin administration may be contributory, most cases of cerebral oedema remain unexplainable . Table lists a series of clinical events which should lead one to be suspicious of the possibility of cerebral oedema, especially if the patient seems to be improving by laboratory parameters but worsening on clinical grounds.…”

Section: Cerebral Oedemamentioning

confidence: 99%

Paediatric and adolescent diabetic ketoacidosis

Brink

2014

Practical Diabetes

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Diabetic ketoacidosis (DKA) is one of the two acute emergency situations in those who have diabetes mellitus. DKA should be identifiable and is often preventable. Any associated complications of DKA should also be preventable with proper education and treatment. Awareness of presenting signs and symptoms, on the part of the general public, primary care providers and emergency department personnel, should help minimise the severity of DKA through earlier diagnosis and focusing on appropriate physiologic treatment as well as close, ongoing monitoring to minimise potential lethal DKA complications such as cerebral oedema. Missed diagnosis, late diagnosis, inappropriate treatment, delayed treatment and lack of appropriate monitoring are usually associated with more morbidity and mortality as well as increased hospital costs. Insulin treatment is only one part of DKA management. Fluid and electrolyte monitoring and treatment are often a critical aspect of such management. All aspects of DKA recognition, treatment and prevention must be emphasised to decrease DKA morbidity and mortality around the world.

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Section: Cerebral Oedemamentioning

confidence: 99%

Paediatric and adolescent diabetic ketoacidosis

Brink

2014

Practical Diabetes

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Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer finding a cause?

Edge

2000

Diabetes Metab. Res. Rev.

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Cerebral oedema remains the leading cause of death and morbidity in children with Type 1 diabetes mellitus. Around seven per thousand episodes of diabetic ketoacidosis (DKA) are complicated by cerebral oedema, and one-quarter of those children will die from it. The cause or causes of cerebral oedema are still very poorly understood, but lawyers are already keen to implicate various aspects of the management of DKA. There have been many theories as to the pathophysiology of cerebral oedema, and possible contributing factors may be excessive rate of rehydration, falling plasma osmolality (particularly that due to a reduction in plasma sodium concentration), hypoxia and insulin dosage. There is some supportive evidence for all of these factors in some cases, but there have been no sizeable case-control studies, in part because of the rarity of the condition. Furthermore, cerebral oedema can still occur even when the management of DKA follows current 'best practice' guidelines. As the mechanisms of cell volume regulation within the brain are increasingly understood, different questions may provide greater insights. For example, what is it about children that makes them so much more susceptible to cerebral oedema than adults? And why does one child treated in a certain way develop cerebral oedema whereas another does not? The anxiety over causing cerebral oedema has driven most of the changes in the management of DKA over recent decades, yet there is no evidence that the incidence has reduced. Until the causes are understood, we cannot be dogmatic about treatment recommendations.

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