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: 10/22/2019)
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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