The Journal of Pediatrics
Volume 150, Issue 5 , Pages 467-473 , May 2007

Preventing a Drop in Effective Plasma Osmolality to Minimize the Likelihood of Cerebral Edema During Treatment of Children with Diabetic Ketoacidosis

  • Ewout J. Hoorn, MD

      Affiliations

    • Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
    • Corresponding Author InformationReprint requests: Ewout J. Hoorn, MD, Dr Molewaterplein 40, Room Bd 391, 3015 GD Rotterdam, The Netherlands.
  • ,
  • Ana P.C.P. Carlotti, MD

      Affiliations

    • Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
  • ,
  • Leila A.A. Costa, MD

      Affiliations

    • Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
  • ,
  • Beth MacMahon, MB

      Affiliations

    • Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
  • ,
  • Gareth Bohn, BSc

      Affiliations

    • Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
  • ,
  • Robert Zietse, MD

      Affiliations

    • Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
  • ,
  • Mitchell L. Halperin, MD

      Affiliations

    • Division of Nephrology, St Michael’s Hospital, University of Toronto, Toronto, Canada
  • ,
  • Desmond Bohn, MB

      Affiliations

    • Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
    • Department of Anesthesia, University of Toronto, Toronto, Canada.

Received 20 December 2005 ,Revised 5 October 2006 ,Accepted 30 November 2006.

References 

  1. Lawrence SE, Cummings EA, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr. 2005;146:688–692
  2. Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin-dependent diabetes, 1990-1996. Arch Dis Child. 1999;81:318–323
  3. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child. 2001;85:16–22
  4. Dunger DB, Edge JA. Predicting cerebral edema during diabetic ketoacidosis. N Engl J Med. 2001;344:302–303
  5. Edge JA. Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer to finding a cause?. Diabetes Metab Res Rev. 2000;16:316–324
  6. Levitsky LL. Symptomatic cerebral edema in diabetic ketoacidosis: the mechanism is clarified but still far from clear. J Pediatr. 2004;145:149–150
  7. Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, et al. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med. 2001;344:264–269
  8. Brown TB. Cerebral oedema in childhood diabetic ketoacidosis: is treatment a factor?. Emerg Med J. 2004;21:141–144
  9. Bello FA, Sotos JF. Cerebral oedema in diabetic ketoacidosis in children. Lancet. 1990;336:64
  10. Durr JA, Hoffman WH, Sklar AH, el Gammal T, Steinhart CM. Correlates of brain edema in uncontrolled IDDM. Diabetes. 1992;41:627–632
  11. Mahoney CP, Vlcek BW, Del Aguila M. Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol. 1999;21:721–727
  12. Duck SC, Weldon VV, Pagliara AS, Haymond MW. Cerebral edema complicating therapy for diabetic ketoacidosis. Diabetes. 1976;25:111–115
  13. Duck SC, Wyatt DT. Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr. 1988;113:10–14
  14. Hale PM, Rezvani I, Braunstein AW, Lipman TH, Martinez N, Garibaldi L. Factors predicting cerebral edema in young children with diabetic ketoacidosis and new-onset type I diabetes. Acta Paediatr. 1997;86:626–631
  15. Harris GD, Fiordalisi I, Harris WL, Mosovich LL, Finberg L. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study. J Pediatr. 1990;117:22–31
  16. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, et al. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child. 2004;89:188–194
  17. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics. 2004;113:e133–e140
  18. Halperin ML, Goldstein MB. In: Fluid, electrolyte, and acid-base physiology. 3rd ed.. Philadelphia: Saunders; 1999;
  19. Glaser NS, Wootton-Gorges SL, Marcin JP, Buonocore MH, Dicarlo J, Neely EK, et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr. 2004;145:164–171
  20. Cameron FJ, Kean MJ, Wellard RM, Werther GA, Neil JJ, Inder TE. Insights into the acute cerebral metabolic changes associated with childhood diabetes. Diabetes Med. 2005;22:648–653
  21. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics. 2004;113:1279–1284
  22. Steele A, Gowrishankar M, Abrahamson S, Mazer CD, Feldman RD, Halperin ML. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Ann Intern Med. 1997;126:20–25
  23. Halperin ML, Goguen JM, Scheich AM, Kamel KS. Clinical consequences of hyperglycemia and its correction. In:  Giebisch G editors. Clinical disturbances of water metabolism. New York: Raven; 1993;p. 249–272
  24. Davids MR, Edoute Y, Stock S, Halperin ML. Severe degree of hyperglycaemia: insights from integrative physiology. QJM. 2002;95:113–124
  25. Van der Meulen JA, Klip A, Grinstein S. Possible mechanism for cerebral oedema in diabetic ketoacidosis. Lancet. 1987;2:306–308
  26. Hoffman WH, Steinhart CM, el Gammal T, Steele S, Cuadrado AR, Morse PK. Cranial CT in children and adolescents with diabetic ketoacidosis. AJNR Am J Neuroradiol. 1988;9:733–739
  27. Krane EJ, Rockoff MA, Wallman JK, Wolfsdorf JI. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Engl J Med. 1985;312:1147–1151
  28. Carlotti AP, Bohn D, Halperin ML. Importance of timing of risk factors for cerebral oedema during therapy for diabetic ketoacidosis. Arch Dis Child. 2003;88:170–173
  29. Inward CD, Chambers TL. Fluid management in diabetic ketoacidosis. Arch Dis Child. 2002;86:443–444
  30. Harris GD, Fiordalisi I. Physiologic management of diabetic ketoacidemia (A 5-year prospective pediatric experience in 231 episodes). Arch Pediatr Adolesc Med. 1994;148:1046–1052
  31. Felner EI, White PC. Improving management of diabetic ketoacidosis in children. Pediatrics. 2001;108:735–740
  32. Shafiee MA, Bohn D, Hoorn EJ, Halperin ML. How to select optimal maintenance intravenous fluid therapy. QJM. 2003;96:601–610
  33. Bohn D, Daneman D. Diabetic ketoacidosis and cerebral edema. Curr Opin Pediatr. 2002;14:287–291
  34. Napolova O, Urbach S, Davids MR, Halperin ML. Assessing the degree of extracellular fluid volume contraction in a patient with a severe degree of hyperglycaemia. Nephrol Dial Transplant. 2003;18:2674–2677
  35. Curtis JR, Bohn D, Daneman D. Use of hypertonic saline in the treatment of cerebral edema in diabetic ketoacidosis (DKA). Pediatr Diabetes. 2001;2:191–194

PII: S0022-3476(06)01176-0

doi: 10.1016/j.jpeds.2006.11.062

The Journal of Pediatrics
Volume 150, Issue 5 , Pages 467-473 , May 2007