Cerebral edema associated with diabetic ketoacidosis: Two case reports

Namatame, Kaoru; Igarashi, Yutaka; Nakae, Ryuta; Suzuki, Go; Shiota, Kohei; Miyake, Nodoka; Ishii, Hirotomo; Yokobori, Shoji

doi:10.1002/ams2.860

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…DKA, a frequent form of presentation in new-onset T1DM [3], is the leading cause of morbidity and mortality in children, mainly due to its potential association with acute complications [4]. Among these complications, the development of cerebral edema stands out as the most concerning outcome, with reported incidences of up to 1% among pediatric DKA patients [5]. Notably, it carries high mortality rates of 20-40% [6], along with the potential for long-term neurologic sequelae [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus

Scutca,

Jugănaru,

Nicoară

et al. 2024

JCM

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(1) Background: Although most cases of new-onset type 1 diabetes mellitus (T1DM) are managed without serious events, life-threatening complications do arise in a subset of patients. Our objective was to assess the correlation between elevated SIRI values and adverse events related to the onset of T1DM. (2) Methods: This retrospective study, spanning ten years, included 187 patients with new-onset T1DM divided into three groups based on SIRI tertiles. The primary outcome was the occurrence of acute complications during hospital admission, while the secondary outcome was prolonged Intensive Care Unit (ICU) admission. (3) Results: Patients with high SIRI values were more likely to experience higher disease activity, leading to longer ICU admission times and more frequent complications. Multivariate logistic regression analysis revealed that the SIRI was independently associated with acute complications (p = 0.003) and prolonged ICU length of stay (p = 0.003). Furthermore, receiver operating characteristic analysis demonstrated the SIRI’s superior predictive accuracy compared to venous pH (AUC = 0.837 and AUC = 0.811, respectively) and to the individual component cell lineages of the SIRI. (4) Conclusions: These findings emphasize the potential utility of the SIRI as a prognostic marker in identifying patients at increased risk during T1DM hospital admissions.

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Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus

Scutca,

Jugănaru,

Nicoară

et al. 2024

JCM

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Aspects of intensive therapy of diabetic ketoacidosis in pediatric practice (literature review)

Bykov,

Muravyeva

2024

Vestn. anesteziol. reanimatol.

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Diabetic ketoacidosis (DKA) is an acute and severe complication of type 1 diabetes mellitus that is associated with a high risk of cerebral edema (CE)and may result in death. DKA is characterized by acute hyperglycemia, ketonemia and metabolic acidosis in the setting of decreased levels of insulin and excessive levels of the counter regulatory hormones. Algorithms of intensive treatment of DKA include such steps as fluid replacement therapy, correction of electrolyte imbalances, and intravenous infusion of insulin, performed in order to resolve metabolic acidosis and hyperglycemia as well as to prevent the development of complications (CE and hypokalemia). The analysis of literature has shown that during fluid replacement the most preferred options are balanced crystalloid solutions (Hartman’s solution and Plasma-Lyte). Infusion therapy is divided into bolus (administration of crystalloid solutions at the rate of 10 ml / kg for 30-60 minutes) and maintenance (administration of solutions for 24-48 hours). Intravenous glucosesolutions (5–10 %) are infused when the patient’s blood glucose falls below 14–16 mmol/L. Electrolyte disturbances (hypokalemia and hyponatremia) are resolved by prompt intravenous infusion of potassium and sodium solutions. Intravenous infusion of insulin is started at the rate of 0.05–0.1 U/kg/h, not earlier than 1 hour after the initiation of fluid resuscitation. Successful treatment of DKA in pediatric practice relies on clear understanding of the pathophysiological mechanisms of this complication and knowledge of the doses of the pharmaceutical drugs and volumes of infusion solutions to be used.

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Cerebral edema in an adolescent patient with diabetic ketoacidosis: a case report with a review of literature

Bykov,

Obedin,

Vorobyova

et al. 2024

Vestn. anesteziol. reanimatol.

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The objective was to describe a case of cerebral edema (CE) in an adolescent patient with type 1 diabetes mellitus (DM) complicated with diabetic ketoacidosis (DKA), and to perform an analysis and review of publications devoted to this topic.Materials and methods. We describe the rare clinical case of CE complicated with DKA in the 14-year-old adolescent patient, including the dynamics of the patient’s clinical condition and laboratory test results. The topic of interest was researched through analysis of publications found in the Cochrane Library, PubMed, eLibrary.ru and Medscape databases using the following search terms: diabetic ketoacidosis, children and adolescents, cerebral edema, intensive therapy. A total of 38 publications in Russian and English were selected for being fully compliant with the purpose of this work. The features of the reported clinical case were analyzed and compared with information obtained from the current scientific literature.Results: This case demonstrates specific features presenting in the course of CE and describes aspects of the intensive treatment provided to the patient. Manifestations of severe hypokalemia and hypernatremia have been recorded as rare electrolyte disturbances in CE in the adolescent with DKA. The report demonstrates that the steps and specific parameters of the provided intensive treatment are unlikely to have triggered the development of CE in the clinic in this particular clinical case. It cannot be ruled out that the development of this complication was triggered by the delayed initiation of treatment (caused by the patient) at the prehospital stage, including the patient’s rude noncompliance with the prescribed insulin treatment scheme.Conclusions. CE is the rare but severe (with a high fatality rate) complication of DKA in patients with type 1 DM. Timely initiation of emergency care for CE may reduce risks associated with this complication and improve treatment outcomes and patient prognosis.

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Cerebral edema associated with diabetic ketoacidosis: Two case reports

Cited by 3 publications

References 10 publications

Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus

Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus

Aspects of intensive therapy of diabetic ketoacidosis in pediatric practice (literature review)

Cerebral edema in an adolescent patient with diabetic ketoacidosis: a case report with a review of literature

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