Cerebral Edema, Diabetes Insipidus, and Sudden Death during the Treatment of Diabetic Ketoacidosis

A young diabetic patient with ketoacidosis responding to standard treatment abruptly developed pulmonary edema, apnea, coma, cardiac arrythmias and diabetes insipidus. At autopsy, cerebral edema and neuronal degeneration were present. In the hypothalamus many neurones were absent. Similar cases have been reported, but the pathogenesis of the syndrome is not understood. The present patient received large amounts of sodium bicarbonate, and significant potassium deficiency may have been present.