UMEM Educational Pearls

Category: Pediatrics

Title: Cerebral Edema and Pediatric DKA

Keywords: DKA, Cerebral Edema, Mannitol, Risk Factors (PubMed Search)

Posted: 2/22/2008 by Sean Fox, MD (Updated: 4/18/2024)
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Cerebral Edema in Patients with DKA

Cerebral Edema is a rare, yet catastrophic complication of Pediatric DKA.
- Occurs in ~1% of episodes of pediatric DKA
- Mortality rate of 40-90%; 20-40% of survivors have lasting Neuro Sequelae.
Risk Factors
- High initial BUN
- Low paCO2
- No increase of the sodium during therapy
- Treatment with bicarbonate
Diagnosis is made clinically
- Warning Signs = Headache, Vomitting, Lethargy, Bradycardia, and Hypertension
- Keep Mannitol (0.25-1.0 grams/kg) at the bedside. Administer it and stop IVF once you suspect Cerebral Edema.
  
  Glaser N, et al: Risk factors for cerebral edema in children with DKA. NEJM.2001:344:264-9