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Previous Volume 344:264-269 January 25, 2001 Number 4 Next

	Full Text PDF Editorial by Dunger, D. B. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined.

Methods In this multicenter study, we identified 61 children who had been hospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema were also identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes (established vs. newly diagnosed disease), initial serum glucose concentration, and initial venous pH. Using logistic regression, we compared the three groups with respect to demographic characteristics and biochemical variables at presentation and compared the matched groups with respect to therapeutic interventions and changes in biochemical values during treatment.

Results A comparison of the children in the cerebral-edema group with those in the random control group showed that cerebral edema was significantly associated with lower initial partial pressures of arterial carbon dioxide (relative risk of cerebral edema for each decrease of 7.8 mm Hg [representing 1 SD], 3.4; 95 percent confidence interval, 1.9 to 6.3; P<0.001) and higher initial serum urea nitrogen concentrations (relative risk of cerebral edema for each increase of 9 mg per deciliter [3.2 mmol per liter] [representing 1 SD], 1.7; 95 percent confidence interval, 1.2 to 2.5; P=0.003). A comparison of the children with cerebral edema with those in the matched control group also showed that cerebral edema was associated with lower partial pressures of arterial carbon dioxide and higher serum urea nitrogen concentrations. Of the therapeutic variables, only treatment with bicarbonate was associated with cerebral edema, after adjustment for other covariates (relative risk, 4.2; 95 percent confidence interval, 1.5 to 12.1; P=0.008).

Conclusions Children with diabetic ketoacidosis who have low partial pressures of arterial carbon dioxide and high serum urea nitrogen concentrations at presentation and who are treated with bicarbonate are at increased risk for cerebral edema.

Source Information

From the Department of Pediatrics (N.G., N.K.) and the Division of Emergency Medicine, Department of Internal Medicine (N.K.), University of California, Davis, School of Medicine, Davis; the Division of Emergency Medicine, Royal Children's Hospital, Melbourne, Australia (P.B.); the Division of Emergency Medicine, Children's Hospital and Health Center, San Diego, Calif. (I.M.); the Department of Pediatrics, Brown University School of Medicine, Providence, R.I. (D.N.); the Division of Emergency Medicine, Children's Memorial Hospital, Chicago (J.T.); the Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia (J.L.); the Department of Pediatrics, University of Southern California School of Medicine, Los Angeles (F.K.); the Department of Pediatrics, Washington University School of Medicine, St. Louis (K.Q.); the Department of Pediatrics, University of Colorado Health Sciences Center, Denver (M.R.); and the Department of Pediatrics, Harvard Medical School, Boston (R.M.). Presented in part at the annual meetings of the Society for Pediatric Research, Boston, May 14, 2000, and the Society for Academic Emergency Medicine, San Francisco, May 25, 2000.

Address reprint requests to Dr. Glaser at the Division of Pediatric Endocrinology, University of California, Davis, Medical Center, 2516 Stockton Blvd., Sacramento, CA 95817, or at nsglaser{at}ucdavis.edu.

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