Preventing a Drop in Effective Plasma Osmolality to Minimize the Likelihood of Cerebral Edema During Treatment of Children with Diabetic Ketoacidosis
Received 20 December 2005; received in revised form 5 October 2006; accepted 30 November 2006.
Refers to article:
Choosing the Right Fluid and Electrolytes Prescription in Diabetic Ketoacidosis
Aaron L. Friedman
The Journal of Pediatrics
May 2007 (Vol. 150, Issue 5, Pages 455-456) Full Text |
Full-Text PDF (57 KB)
Objectives
To test whether a drop in effective plasma osmolality (PEff osm; 2 × plasma sodium [PNa] + plasma glucose concentrations) during therapy for diabetic ketoacidosis (DKA) is associated with an increased risk of cerebral edema (CE), and whether the development of hypernatremia to prevent a drop in the PEff osm is dangerous.
Study design
This study is a retrospective comparison of a CE group (n = 12) and non-CE groups with hypernatremia (n = 44) and without hypernatremia (n = 13).
Results
The development of CE (at 6.8 ± 1.5 hours) was associated with a drop in PEff osm from 304 ± 5 to 290 ± 5 mOsm/kg (P < .001). Control patients did not show this drop in PEff osm at 4 hours (1 ± 2 and 2 ± 2 vs –9 ± 2 mOsm/kg; P < .01), because of a larger rise in PNa and/or a smaller drop in plasma glucose. During this period, the CE group received more near-isotonic fluids (69 ± 9 vs 35 ± 2 and 27 ± 3 mL/kg; P < .001). The CE group had a higher mortality (3/12 vs 0/57; P = .003), and more neurologic sequelae (5/12 vs 1/57; P < .001).
Conclusions
CE during therapy for DKA was associated with a drop in PEff osm. An adequate rise in PNa may be needed to prevent this drop in PEff osm.
ABSTRACT