N. Agarwal, C. Dave, R. Patel, R. Shukla, R. Kapoor and A. Bajpai (2020). Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis. Indian pediatrics, 57(4), 310-313.

PubMed 32038036

[Abstract]
OBJECTIVE: To evaluate the time course and predictors of cerebral edema in diabetic ketoacidosis (DKA).

METHODS: Review of hospital records of 107 episodes of DKA between January 2013 to March 2019.

RESULTS: Cerebral edema was identified in 26 (24.3%; 22 at presentation and 4 during treatment). Cerebral edema at presentation was associated with lower (<10 mmHg) arterial carbon dioxide (OR 3.6, 95% CI 1.0,12.7; P=0.04), prior fluid treatment (OR 4.7, 95% CI 1.8,12.7; P=0.001) and new onset diabetes (OR 3.5, 95% CI 1.1,11.1; P=0.03). Prior fluid was the only significant predictor on multivariate analysis (P=0.013). Cerebral edema resulted in a longer ICU stay [4.1 (2.3) vs 1.8 (0.9) d; P<0.001].

CONCLUSIONS: Cerebral edema at admission is common in Indian children with DKA and should be suspected with severe metabolic acidosis and inappropriate prior fluid treatment.