Is Age a Risk Factor for Cerebral Edema in Children With Diabetic Ketoacidosis? A Literature Review

Abstract

Key MessagesPublished data do not support the view that young age is a risk factor for cerebral edema development in children with diabetic ketoacidosis at the time of diagnosis. Younger children are at a higher risk for the development of diabetic ketoacidosis, in particular during the first 2 to 3 years of life. Whether diabetic ketoacidosis is more severe in younger children remains unclear. Keywords:cerebral edema children diabetic ketoacidosis review type 1 diabetes younger age a b s t r a c t Cerebral edema (CE) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA) in children with type 1 diabetes. CE is frequently mentioned as being more common in young children. The primary objective of this study was to review the evidence suggesting that younger age is a risk factor for the development of CE during DKA. The secondary objective was to assess if younger children are at a higher risk of DKA and severe DKA. A literature review was performed, and studies which reported the frequency of CE, DKA and severe DKA in children <3 and 3 to 5 years of age were included. Among the 6 studies reporting the frequency of CE that were identified, 5 good-quality studies found no significant association between younger age and higher risk of CE. Twenty-seven studies (DKA frequency: 11.3% to 54%) reported DKA frequency as a function of age. Most published studies found a higher frequency of DKA in children <5 years of age (20/25 studies), and in particular in those in the first 2 to 3 years of life (8/8 studies). There was inconclusive evidence to determine whether the severity of DKA was influenced by age. In conclusion, the commonly held view that CE is more common in younger children is not supported by the existing literature. Published data suggest that DKA (and possibly severe DKA) is more common in very young children. Regardless of age, all children with DKA should be monitored carefully for the development of CE.Ó 2019 Canadian Diabetes Association.Mots clés: oedème cérébral enfants acidocétose diabétique revue diabète de type 1 de plus bas âge r é s u m é L'oedème cérébral (OC) est une complication rare, mais potentiellement fatale de l'acidocétose diabétique (ACD) chez les enfants atteints du diabète de type 1. On mentionne souvent que l'OC est plus fréquent chez les jeunes enfants. L'objectif principal de la présente étude était d'examiner les données probantes qui montrent que les enfants de plus bas âge qui sont atteints d'ACD sont exposés au risque de développer un OC. L'objectif secondaire était d'évaluer si les enfants de plus bas âge sont exposés à un risque plus élevé d'ACD et d'ACD grave. Dans la revue de littérature réalisée, nous avons sélectionné les études qui rapportaient la fréquence de l'OC, l'ACD et l'ACD grave chez les enfants âgés de < 3 ans et de 3

A Multicenter Survey of Type I Diabetes Mellitus in Chinese Children

“…According to a previous study, DKA was more frequently encountered in children <5 years of age ( 25 ). Another study reported that severe DKA was more common in children <3 years of age ( 26 ). At presentation, the mean age in DKA group was significantly lower than that in non-DKA group.…”

“…Early symptoms of diabetes may be missed in young children because frequent vomiting and increased work of breathing which are frequently observed symptoms may be expected by health care worker as well as parents to be from other explanations. Younger children are less likely to have free access to fluids and may be more severely dehydrated and acidotic at presentation ( 26 ).…”

Risk Factors and Laboratory Findings Associated With Diabetic Ketoacidosis in Hospitalized Pediatric Patients

“…The risk factors that were significantly associated with a probability of obtaining radiological imaging for altered mental status were older age of the patients and elevated BUN (Table 3 ). Studies have shown that the risk factors associated with cerebral edema in DKA are age under five years, high BUN, low pCO 2 , administration of sodium bicarbonate, and degree of dehydration [ 6 , 13 ].…”