Diabetic ketoacidosis and pediatric stroke

Cerebral edema in diabetic ketoacidosis

“…As indicated earlier, patients with minor criteria alone may not be diagnosable by clinical means. Other intracranial pathology may exist in as many as 10% to 20% of symptomatic patients (11,54,123,137,(152)(153)(154)(155)(156)(157)(158)(159). Processes to consider include hypoglycemia, nonketotic hyperosmolality, drug ingestions, infection (e.g., meningitis, encephalitis), hemorrhage (spontaneous or traumatic), thrombosis, emboli, stroke, infarction, extrapontine myelinosis, obstructive hydrocephalus, and trauma.…”

Acute obstructive hydrocephalus as a complication of diabetic ketoacidosis in a child with prior communicating hydrocephalus

“…DKA is the most feared life threatening emergency and the leading cause of death in a child with diabetes 2 . DKA is defined as serum glucose concentration more than 300mg/dl, blood bicarbonate less than 15mmol/L, venous pH less than 7.25 and the presence of ketones in the urine 3,4 . One important challenge in DKA is the vulnerability to intracerebral complications and the subsequent neurological deterioration.…”

Cerebral Accidents in Pediatric Diabetic Ketoacidosis: Different Complications and Different Evolutions

“…Ischemic and hemorrhagic strokes are less frequent, representing approximately 10% of intracerebral complications of DKA [5,6], with a risk of neurologic sequelae and a mortality rate of 7-28% [7]. Cerebral edema may occur before or during DKA treatment depending on the factors related to DKA presentation (young age, high degree of hypocapnia, high serum urea nitrogen concentration, elevated serum osmolality, severe acidosis, and dehydration) and, moreover, the factors related to DKA treatment (excessive rehydration, administration of insulin in the first hours, and bicarbonate infusion) [8,9].…”