Risk of cerebral edema in children with diabetic ketoacidosis in the course of type 1 diabetes

Pyziak, Aleksandra; Młynarski, Wojciech; Zmysłowska, Agnieszka

doi:10.18544/pedm-21.04.0039

Cited by 1 publication

(2 citation statements)

References 42 publications

(104 reference statements)

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“…However, even in countries such as Germany and Austria, newly diagnosed patients still present with DKA at rates of over 30%. In patients with a previously diagnosed T1DM, adolescent patients are at risk, and the most common cause is skipping the insulin dose, technical problems with the pump in patients using an insulin pump, and infection [3,16].…”

Section: Introductionmentioning

confidence: 99%

“…Factors constituting the clinical picture in DKA are, in addition to insulin deficiency, dehydration, and increased hormones such as adrenaline, cortisol, glucagon, and growth hormone that are effective against insulin. Patients also have serious intracellular dehydration due to intravascular hyperosmolarity and this dehydration develops over a long period [3,16]. Rapid reduction of intravascular hyperosmolality causes swelling of cells and hypokalemia, leading to an increase in morbidity and mortality rates associated with DKA [3,17].…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Analysis of Children and Adolescents With Diabetic Ketoacidosis in the Intensive Care Unıt: Is It Significant that the Blood Ketone Level Becomes Negative in Diabetic Ketoacidosis?

Kangin

Talay

Yılmaz

et al. 2020

Cureus

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Introduction: Diabetic ketoacidosis (DKA) is the most common cause of acute morbidity and mortality in children and adolescents with type 1 diabetes mellitus (T1DM). Because DKA management is associated with complications, endocrine communities have published guidelines and attempted to set standards for DKA diagnosis and management worldwide. In this study, for the patients followed up in the intensive care unit who have been treated according to DKA protocols, clinical and laboratory characteristics, differences between new and old diagnosed patients, and results of treatment were evaluated. Methods: The records of 67 patients hospitalized in the pediatric intensive care unit for the past two years were reviewed retrospectively. Patients were grouped as newly diagnosed and old diagnosed diabetics. Results: The mean age of the patients was 8.66 ± 5.0 years (3 months to 17.9 years) and 39 (58.2%) were male. Forty-five patients (67.1%) presented with mild DKA and 22 (33.9%) with severe DKA. Fourteen (63.6%) of the severe DKA cases were newly diagnosed with T1DM. Six patients had hyponatremia (corrected serum Na level <135 mmol/L) and five had hypernatremia (serum Na level >145 mmol/L). Only one of the hyponatremic patients had severe acidosis, while four of the hypernatremic patients had severe acidosis. At the 14th hour, blood glucose levels were below 200 mg/dl, blood ketones became negative in 5.8 hours, and at 9.1 hours, blood pH and/or HCO 3 levels were normalized, recovery criteria were completed, and subcutaneous (SC) insulin injection was started. Of the patients, 38 (56.7) were newly diagnosed with T1DM. The mean age of newly diagnosed T1DM patients was smaller (7.40 ± 4.96) than those with old diagnosis, respiratory rates (RRs) were higher and pCO 2 levels were lower on admission. Blood glucose, blood ketone negativity, acidosis, and Glasgow coma score (GCS) scores of the newly diagnosed T1DM patients improved later than the previous diagnoses. Only one patient under two years of age with a pH of 6.89 was given HCO 3. None of the patients had symptomatic brain edema and death. Conclusions: As a result, DKA is an acute and serious complication of diabetes, whose results are promising when managed only with minimal individual changes according to guidelines. Bicarbonate administration is not needed except in patients with very severe acidosis. Bedside blood ketone monitoring seems to be important because it allows for early enteral feeding.

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Section: Introductionmentioning

confidence: 99%