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. 2001 Jul;85(1):16–22. doi: 10.1136/adc.85.1.16

The risk and outcome of cerebral oedema developing during diabetic ketoacidosis

J Edge 1, M Hawkins 1, D Winter 1, D Dunger 1, S GREENE 1
PMCID: PMC1718828  PMID: 11420189

Abstract

BACKGROUND—Cerebral oedema is a major cause of morbidity and mortality in children with insulin dependent diabetes.
AIMS—To determine the risk and outcome of cerebral oedema complicating diabetic ketoacidosis (DKA).
METHODS—All cases of cerebral oedema in England, Scotland, and Wales were reported through the British Paediatric Surveillance Unit between October 1995 and September 1998. All episodes of DKA were reported by 225 paediatricians identified as involved in the care of children with diabetes through a separate reporting system between March 1996 and February 1998. Further information about presentation, management, and outcome was requested about the cases of cerebral oedema. The risk of cerebral oedema was investigated in relation to age, sex, seasonality, and whether diabetes was newly or previously diagnosed.
RESULTS—A total of 34 cases of cerebral oedema and 2940 episodes of DKA were identified. The calculated risk of developing cerebral oedema was 6.8 per 1000 episodes of DKA. This was higher in new (11.9 per 1000 episodes) as opposed to established (3.8 per 1000) diabetes. There was no sex or age difference. Cerebral oedema was associated with a significant mortality (24%) and morbidity (35% of survivors).
CONCLUSIONS—This first large population based study of cerebral oedema complicating DKA has produced risk estimates which are more reliable and less susceptible to bias than those from previous studies. Our study indicates that cerebral oedema remains an important complication of DKA during childhood and is associated with significant morbidity and mortality. Little is known of the aetiology of cerebral oedema in this condition and we are currently undertaking a case control study to address this issue.



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Selected References

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  1. Bello F. A., Sotos J. F. Cerebral oedema in diabetic ketoacidosis in children. Lancet. 1990 Jul 7;336(8706):64–64. doi: 10.1016/0140-6736(90)91587-z. [DOI] [PubMed] [Google Scholar]
  2. Duck S. C., Kohler E. Cerebral edema in diabetic ketoacidosis. J Pediatr. 1981 Apr;98(4):674–676. doi: 10.1016/s0022-3476(81)80813-x. [DOI] [PubMed] [Google Scholar]
  3. Duck S. C., Wyatt D. T. Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr. 1988 Jul;113(1 Pt 1):10–14. doi: 10.1016/s0022-3476(88)80521-3. [DOI] [PubMed] [Google Scholar]
  4. Durr J. A., Hoffman W. H., Sklar A. H., el Gammal T., Steinhart C. M. Correlates of brain edema in uncontrolled IDDM. Diabetes. 1992 May;41(5):627–632. doi: 10.2337/diab.41.5.627. [DOI] [PubMed] [Google Scholar]
  5. Edge J. A., Ford-Adams M. E., Dunger D. B. Causes of death in children with insulin dependent diabetes 1990-96. Arch Dis Child. 1999 Oct;81(4):318–323. doi: 10.1136/adc.81.4.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Franklin B., Liu J., Ginsberg-Fellner F. Cerebral edema and ophthalmoplegia reversed by mannitol in a new case of insulin-dependent diabetes mellitus. Pediatrics. 1982 Jan;69(1):87–90. [PubMed] [Google Scholar]
  7. Glaser N., Barnett P., McCaslin I., Nelson D., Trainor J., Louie J., Kaufman F., Quayle K., Roback M., Malley R. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001 Jan 25;344(4):264–269. doi: 10.1056/NEJM200101253440404. [DOI] [PubMed] [Google Scholar]
  8. Greene S. A., Jefferson I. G., Baum J. D. Cerebral oedema complicating diabetic ketoacidosis. Dev Med Child Neurol. 1990 Jul;32(7):633–638. doi: 10.1111/j.1469-8749.1990.tb08548.x. [DOI] [PubMed] [Google Scholar]
  9. Haines L. C., Swift P. G. Report of the 1994 BPA/BDA Survey of Services for Children with Diabetes: Changing Patterns of Care. British Paediatric Association/British Diabetic Association. Diabet Med. 1997 Aug;14(8):693–697. doi: 10.1002/(SICI)1096-9136(199708)14:8<693::AID-DIA412>3.0.CO;2-T. [DOI] [PubMed] [Google Scholar]
  10. Hale P. M., Rezvani I., Braunstein A. W., Lipman T. H., Martinez N., Garibaldi L. Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes. Acta Paediatr. 1997 Jun;86(6):626–631. doi: 10.1111/j.1651-2227.1997.tb08946.x. [DOI] [PubMed] [Google Scholar]
  11. Hall S. M., Glickman M. Report from the British Paediatric Surveillance Unit. Arch Dis Child. 1990 Jul;65(7):807–809. doi: 10.1136/adc.65.7.807. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hammond P., Wallis S. Cerebral oedema in diabetic ketoacidosis. BMJ. 1992 Jul 25;305(6847):203–204. doi: 10.1136/bmj.305.6847.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Harris G. D., Fiordalisi I., Harris W. L., Mosovich L. L., Finberg L. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study. J Pediatr. 1990 Jul;117(1 Pt 1):22–31. doi: 10.1016/s0022-3476(05)82439-4. [DOI] [PubMed] [Google Scholar]
  14. Harris G. D., Fiordalisi I. Physiologic management of diabetic ketoacidemia. A 5-year prospective pediatric experience in 231 episodes. Arch Pediatr Adolesc Med. 1994 Oct;148(10):1046–1052. doi: 10.1001/archpedi.1994.02170100044009. [DOI] [PubMed] [Google Scholar]
  15. Hernández-Pando R., Jeyanathan M., Mengistu G., Aguilar D., Orozco H., Harboe M., Rook G. A., Bjune G. Persistence of DNA from Mycobacterium tuberculosis in superficially normal lung tissue during latent infection. Lancet. 2000 Dec 23;356(9248):2133–2138. doi: 10.1016/s0140-6736(00)03493-0. [DOI] [PubMed] [Google Scholar]
  16. Hoffman W. H., Steinhart C. M., el Gammal T., Steele S., Cuadrado A. R., Morse P. K. Cranial CT in children and adolescents with diabetic ketoacidosis. AJNR Am J Neuroradiol. 1988 Jul-Aug;9(4):733–739. [PMC free article] [PubMed] [Google Scholar]
  17. Krane E. J., Rockoff M. A., Wallman J. K., Wolfsdorf J. I. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Engl J Med. 1985 May 2;312(18):1147–1151. doi: 10.1056/NEJM198505023121803. [DOI] [PubMed] [Google Scholar]
  18. Krane E. J., Rockoff M. A., Wallman J. K., Wolfsdorf J. I. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Engl J Med. 1985 May 2;312(18):1147–1151. doi: 10.1056/NEJM198505023121803. [DOI] [PubMed] [Google Scholar]
  19. McAloon J., Carson D., Crean P. Cerebral oedema complicating diabetic ketoacidosis. Acta Paediatr Scand. 1990 Jan;79(1):115–117. doi: 10.1111/j.1651-2227.1990.tb11343.x. [DOI] [PubMed] [Google Scholar]
  20. Mel J. M., Werther G. A. Incidence and outcome of diabetic cerebral oedema in childhood: are there predictors? J Paediatr Child Health. 1995 Feb;31(1):17–20. doi: 10.1111/j.1440-1754.1995.tb02905.x. [DOI] [PubMed] [Google Scholar]
  21. Morris A. D., Boyle D. I., McMahon A. D., Greene S. A., MacDonald T. M., Newton R. W. Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet. 1997 Nov 22;350(9090):1505–1510. doi: 10.1016/s0140-6736(97)06234-x. [DOI] [PubMed] [Google Scholar]
  22. Pinkey J. H., Bingley P. J., Sawtell P. A., Dunger D. B., Gale E. A. Presentation and progress of childhood diabetes mellitus: a prospective population-based study. The Bart's-Oxford Study Group. Diabetologia. 1994 Jan;37(1):70–74. doi: 10.1007/BF00428780. [DOI] [PubMed] [Google Scholar]
  23. Rosenbloom A. L. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care. 1990 Jan;13(1):22–33. doi: 10.2337/diacare.13.1.22. [DOI] [PubMed] [Google Scholar]
  24. Silver S. M., Clark E. C., Schroeder B. M., Sterns R. H. Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis. Kidney Int. 1997 Apr;51(4):1237–1244. doi: 10.1038/ki.1997.169. [DOI] [PubMed] [Google Scholar]
  25. Wood E. G., Go-Wingkun J., Luisiri A., Aceto T., Jr Symptomatic cerebral swelling complicating diabetic ketoacidosis documented by intraventricular pressure monitoring: survival without neurologic sequela. Pediatr Emerg Care. 1990 Dec;6(4):285–288. doi: 10.1097/00006565-199012000-00009. [DOI] [PubMed] [Google Scholar]

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