Cerebral edema in a child with diabetic ketoacidosis before initial treatment

Takaya, Junji; Ohashi, Reiko; Harada, Yoshiaki; Yamato, Fumiko; Higashino, Hirohiko; Kobayashi, Yohnosuke; Kaneko, Kazunari

doi:10.1111/j.1442-200x.2007.02361.x

Cited by 4 publications

(1 citation statement)

References 11 publications

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“…There is evidence that many patients with DKA have some degree of subclinical cerebral edema even before starting treatment. 3,13,14,16,[30][31][32][33] Clinical manifestations of cerebral edema are usually sudden, and there may be fast progression to brain herniation, even when clinical status is recognized and aggressively treated. 31 Cerebral edema usually occurs within 4-12 hours after beginning treatment and at the moment acidosis, dehydration and hyperglycemia, as well as the patient's general status, are improving.…”

Section: Cerebral Edemamentioning

confidence: 99%

Perspectivas atuais do tratamento da cetoacidose diabética em pediatria

Piva¹,

Czepielewski²,

García³

2007

J. Pediatr. (Rio J.)

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Objective: To review current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema. Sources:The authors selected articles from MEDLINE with the keywords diabetes, ketoacidosis, hyperglycemia and cerebral edema, and priority was given to studies including children and that contained complete texts published in English, Portuguese or Spanish. Chapters of books published in Brazil describing the treatment of DKA in pediatric intensive care unit were also reviewed. Based on the reviewed literature and on the author's experience, the most efficient and recommended measures for DKA management are presented. Summary of the findings:Normal saline solution (NaCl 0.9%) has been increasingly used for fast replacement and hydration, as a substitute to diluted (hypotonic) solutions, as well as contraindication of sodium bicarbonate to repair metabolic acidosis in DKA. Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. For fast corrections of glucose oscillations, a practical scheme using two bags of electrolytic solutions is presented. Cerebral edema, its physiopathological mechanism and current treatment are reviewed. Conclusions:Use of continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.J Pediatr (Rio J). 2007;83(5 Suppl):S119-127: Diabetes, acidosis, dehydration, insulin, cerebral edema.

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Section: Cerebral Edemamentioning

confidence: 99%

Perspectivas atuais do tratamento da cetoacidose diabética em pediatria

Piva¹,

Czepielewski²,

García³

2007

J. Pediatr. (Rio J.)

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Diabetic Ketoacidosis

Piva

García

Branco

2014

Pediatric Critical Care Medicine

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The current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema are reviewed in this chapter. Based on the reviewed literature and on the author's experience, the most effi cient and recommended measures for DKA management are presented.Among the main fi ndings we would remark: (a) Normal saline solution (NaCl 0.9 %) remains as the preferred hydration solution. Hypotonic (diluted) solutions are avoided in the treatment of DKA. (b) there is a consensus regarding the contraindication of sodium bicarbonate administration to repair metabolic acidosis in DKA. (c) Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. In small babies with KAD and new onset diabetes, low insulin infusion rates (0.05 IU/kg/h) has been associated with few hypoglycemic episodes as well as with lower impact on the osmolarity, being protective for cerebral edema; (d) For fast corrections of glucose oscillations during DKA treatment, a practical scheme using two bags of electrolytic solutions is presented. (e) Cerebral edema, associated with DKA is a multifactorial process with different pathophysiological mechanisms. Depending on the associated risk for cerebral edema the most efficient treatment measures are reviewed.In conclusion: continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.

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Diabetic Ketoacidosis in the Pediatric Emergency Department

Olivieri

Chasm

2013

Emergency Medicine Clinics of North America

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Cerebral edema in a child with diabetic ketoacidosis before initial treatment

Cited by 4 publications

References 11 publications

Perspectivas atuais do tratamento da cetoacidose diabética em pediatria

Perspectivas atuais do tratamento da cetoacidose diabética em pediatria

Diabetic Ketoacidosis

Diabetic Ketoacidosis in the Pediatric Emergency Department

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