Cerebral Edema in Childhood Diabetic Ketoacidosis

• Published in: Diabetes care Vol. 27; no. 7; pp. 1541 - 1546
• Main Authors: Muir, Andrew B., Quisling, Ronald G., Yang, Mark C.K., Rosenbloom, Arlan L.
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01-07-2004
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.27.7.1541

Cerebral Edema in Childhood Diabetic Ketoacidosis
Natural history, radiographic findings, and early identification
Andrew B. Muir , MD 1 ,
Ronald G. Quisling , MD 2 ,
Mark C.K. Yang , PHD 3 and
Arlan L. Rosenbloom , MD 1
1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
2 Department of Radiology, University of Florida College of Medicine, Gainesville, Florida
3 Department of Statistics, University of Florida College of Medicine, Gainesville, Florida
Address correspondence and reprint requests to Andrew Muir, MD, 1120 15th St., BG-1020, Augusta, GA 30912. E-mail: amuir{at}mcg.edu
Abstract
OBJECTIVE —Children who develop cerebral edema (CE) during diabetic ketoacidosis (DKA) exhibit definable signs and symptoms of neurological
collapse early enough to allow intervention to prevent brain damage. Our objective was to develop a model for early detection
of CE in children with DKA.
RESEARCH DESIGN AND METHODS —A training sample of 26 occurrences of DKA complicated by severe CE and 69 episodes of uncomplicated DKA was reviewed. Signs
of neurological disease were incorporated into a bedside evaluation protocol that was applied to an independent test sample
of 17 patients previously reported to have developed symptomatic CE during treatment for DKA. Head computed tomograms and
their reports were reviewed.
RESULTS —The protocol allowed 92% sensitivity and 96% specificity for the recognition of CE sufficiently early for intervention. The
diagnostic criteria were fulfilled in two temporal patterns, defining early- and late-onset CE. Although initial computed
tomograms were often normal, the findings also included diffuse CE and focal brain injury, the latter only in patients with
an early onset of abnormal neurological signs.
CONCLUSIONS —CE may occur in the absence of acute changes on head computed tomograms. Early detection of CE at the bedside using an evidence-based
protocol permits intervention in time to prevent permanent brain damage.
CE, cerebral edema
CT, computed tomography
DKA, diabetic ketoacidosis
ROC, receiver-operating characteristic
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted April 1, 2004.
Received December 12, 2003.
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