Ketoacid levels may alter osmotonicity in diabetic ketoacidosis and precipitate cerebral edema

Inward and Chambers1 have called for a rethink of the management of diabetic ketoacidosis. In their article they quote a study by Grove L M and colleagues2 suggesting that pediatricians overestimated the quantum of dehydration in DKA. Over correction of dehydration is implicated in precipitating cerebral oedema. On the face of it, it seems implausible that pediatricians who are so adapt at estimating dehydration in the context of gastroenteritis, diarrhea, and vomiting should err in estimating the dehydration in DKA, unless the dehydration of DKA has special features. Hypertonicity may be that special feature. We hypothesize that …