Subclinical cerebral edema in diabetic ketoacidosis in children

Agarwal, Hemant

doi:10.1002/ccr3.1960

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…~ 5 ~ days (mean hospital stay of 5.6 days) which is comparable to the data from North India [2] . None of the participants in our study developed cerebral oedema and the reported incidence of cerebral edema in DKA patients in pediatric population is 0.5-1% in some studies [16,17] . Predicted mortality in DKA according to literature ranges from 0.15% to 0.35% in developed countries and 3.4% to 13.4% in developing countries including India [18,19] .…”

Section: Discussionmentioning

confidence: 52%

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Kuriakose¹,

Francis²,

George³

et al. 2023

Int. J. Paediatrics Geriatrics

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To study clinical profile and outcome of children admitted with diabetic ketoacidosis in our tertiary care centre during the pre and post covid period (Jan 2016 -Jan 2022). Materials and Methods: Hospital-based cohort study among the children admitted with DKA in the department of Paediatrics. We abstracted the data of children, satisfying the inclusion criteria as per the pre-designed proforma based on ISPAD 2018 guidelines. Participants: 46 children admitted with diagnosis of DKA during the study period, in a tertiary care centre in Kerala. Results: Total of 46 admissions with DKA including 16 readmissions in 30 children were enrolled in the study. Majority (95.65%) were Type 1 DM with mean age of 11.6 years and male to female ratio of 1.1:1. There were 11.5 admission per year after the Covid 19 outbreak, compared to 5.8 cases per year during the pre-covid period. Most of the patients (60.9%) had only a short duration of symptoms (≤ 3 days) at presentation, and vomiting was the commonest symptom (63%), followed by polyuria, polydipsia (60.9%). 47.8% patients presented with mild DKA followed by 34.8% as severe DKA and majority (60.9%) needed 4 to 7 days of hospital stay. Conclusion: DKA is a leading cause of morbidity and mortality in children with diabetes. There is a significant increase in the frequency of children getting admitted with DKA in the post Covid period which may be due to the delay in diagnosing the condition because of sedentary life style during lockdown, unhealthy eating habits and poor utilization of health care system by the public during the early surge of COVID peak.

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Section: Discussionmentioning

confidence: 52%

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Kuriakose¹,

Francis²,

George³

et al. 2023

Int. J. Paediatrics Geriatrics

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“…Also, the highest amount of ONSD was seen in children with moderate to severe DKA. ONSD, which indicates an increase in intracranial pressure, can be measured by bedside ultrasound, shows many changes during treatment of children with DKA, and reaches its highest values in the middle of treatment (47). In Hansen et al's study on ONSD sonography, it was found that subtle changes in ONSD may occur despite the absence of clinical signs of cerebral edema, but it is unclear to what extent these changes reflect actual changes in intracranial pressure (45).…”

Section: Discussionmentioning

confidence: 99%

Predisposing Factors of Cerebral Edema in Pediatric Diabetic Ketoacidosis: A Systematic Review

Jafari

Dadashian

Ghaffari

et al. 2022

JPR

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Background: diabetic ketoacidosis (DKA) is not the most common acute complication of type 1 diabetes in children and adolescents, But the cerebral edema caused by it is the most common cause of death in children with DKA. Objectives: The purpose of this study was to systematically review the literature to describe of the Predisposing factors of cerebral edema in Pediatric Diabetic Ketoacidosis. Methods: sex international databases of Wiley, Medline, Scopus, web of science, ProQuest and Cochrane Library s, and three domestic databases, including SID, Magiran and Iranmedex were searched for relevant studies. Then, articles with inclusion criteria and related to the objectives of this study were reviewed. Results: These studies have identified several risk factors for cerebral edema, some of which are related to the severity of the disease at admission and some of which are related to treatment. Conclusion: Preventing DKA is the only reliable way to prevent cerebral edema until the causes of this life-threatening complication are fully understood.

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“…Osmotic shifts and other therapy‐related factors during treatment may further exacerbate cerebral injury. However, both subclinical 12,13,154 and clinically apparent CE 4,14‐18 have been described before starting therapy, suggesting that reperfusion injury and treatment‐related factors are not necessary components of the pathophysiologic pathway leading to CE development, but may play a role in propagating cerebral injury in a subset of predisposed patients (i.e., those with more severe dehydration and acidosis at presentation). Figure 1 shows a proposed multifactorial pathway leading to the development of the different types of cerebral injury in patients with DKA.…”

Section: Discussionmentioning

confidence: 99%

Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral edema

2020

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Cerebral edema (CE) is a potentially devastating complication of diabetic ketoacidosis (DKA) that almost exclusively occurs in children. Since its first description in 1936, numerous risk factors have been identified; however, there continues to be uncertainty concerning the mechanisms that lead to its development. Currently, the most widely accepted hypothesis posits that CE occurs as a result of ischemia–reperfusion injury, with inflammation and impaired cerebrovascular autoregulation contributing to its pathogenesis. The role of specific aspects of DKA treatment in the development of CE continues to be controversial. This review critically examines the literature on the pathophysiology of CE and attempts to categorize the findings by types of brain injury that contribute to its development: cytotoxic, vasogenic, and osmotic. Utilizing this scheme, we propose a multifactorial pathway for the development of CE in patients with DKA.

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Subclinical cerebral edema in diabetic ketoacidosis in children

Cited by 7 publications

References 21 publications

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Predisposing Factors of Cerebral Edema in Pediatric Diabetic Ketoacidosis: A Systematic Review

Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral edema

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