Key Points
- To identify clinical characteristics at presentation and therapeutic interventions associated with the development of cerebral edema in children hospitalized for diabetic ketoacidosis.
- Conducted a multicenter study examining 61 children hospitalized for diabetic ketoacidosis over a 15-year period who developed cerebral edema.
- Identified two control groups without cerebral edema: 181 randomly selected children and 174 children matched for age, diabetes onset type, baseline glucose, and venous pH.
- Used multivariable logistic regression to evaluate baseline biochemical variables across all groups and therapeutic interventions between matched groups.
- Cerebral edema was independently associated with lower baseline arterial carbon dioxide (RR 3.4 per 7.8 mm Hg decrease, 95% CI 1.9 to 6.3, P<0.001) and higher initial serum urea nitrogen (RR 1.7 per 9 mg/dL increase, 95% CI 1.2 to 2.5, P=0.003) versus random controls.
- Treatment with bicarbonate was significantly associated with the development of cerebral edema after adjusting for baseline covariates in the matched cohort (RR 4.2, 95% CI 1.5 to 12.1, P=0.008).
Structured PICO
What are the risk factors for cerebral edema in children with diabetic ketoacidosis?
PPopulation416 children hospitalized for diabetic ketoacidosis (61 with cerebral edema, 181 random controls, 174 matched controls)
IInterventionRisk factors including lower initial partial pressures of arterial carbon dioxide, higher initial serum urea nitrogen concentrations, and treatment with bicarbonate
CComparatorChildren with diabetic ketoacidosis without cerebral edema
OOutcomeDevelopment of cerebral edemahard clinical
In children with diabetic ketoacidosis, low partial pressures of arterial carbon dioxide, high serum urea nitrogen concentrations, and treatment with bicarbonate are associated with an increased risk of cerebral edema.