Cerebral edema in DKA: Difference between revisions
m (Rossdonaldson1 moved page Cerebral Edema in DKA to Cerebral edema in DKA) |
|||
| Line 22: | Line 22: | ||
==Workup== | ==Workup== | ||
==Management== | ==Management<ref>Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5</ref>== | ||
*Head of bed at 30 degrees | |||
*Stat head CT (non-contrast) | |||
*Mannitol 0.5-1gm/kg IV bolus over 20 minutes | *Mannitol 0.5-1gm/kg IV bolus over 20 minutes | ||
**Give a repeat does if there is an inadequate response | **Give a repeat does if there is an inadequate response | ||
**If 2 doses of mannitol are ineffective, consider 3% saline 10mL/kg over 30min | **If 2 doses of mannitol are ineffective, consider 3% saline 10mL/kg over 30min | ||
*Fluid restriction - decrease the IVF infusion rate by 30% | *Fluid restriction - decrease the IVF infusion rate by 30% | ||
* | **Treat noncardiogenic [[pulmonary edema]], if present | ||
*Consult PICU and neurosurgery | |||
==Disposition== | ==Disposition== | ||
Revision as of 22:55, 23 December 2014
Background
- Almost all affected pts are <20yr [1]
- Associated with initial bicarb level; not rate of glucose drop
Risk Factors
- Age <5yo
- Severe hyperosmolality
- Failure of Na to rise w/ therapy
- Severe acidosis
- Overaggressive fluid resuscitation is NOT a risk factor
Clinical Features
- Begins 6-12hr after onset of therapy or may begin before initiation of treatment or up to 48h afterward
- Many appear to be improving from their DKA before deteriorating from cerebral edema
- Premonitory symptoms:
- Headache
- Incontinence
- Mental Status Change / Seizure
Differential Diagnosis
Workup
Management[2]
- Head of bed at 30 degrees
- Stat head CT (non-contrast)
- Mannitol 0.5-1gm/kg IV bolus over 20 minutes
- Give a repeat does if there is an inadequate response
- If 2 doses of mannitol are ineffective, consider 3% saline 10mL/kg over 30min
- Fluid restriction - decrease the IVF infusion rate by 30%
- Treat noncardiogenic pulmonary edema, if present
- Consult PICU and neurosurgery
Disposition
Admit ICU
See Also
Sources
- Tintinalli 7th edition
- ↑ Glaser NS, Wootton-Gorges SL, Buonocore MH, Marcin JP, Rewers A, Strain J, et al. Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr Diabetes. Apr 2006;7(2):75-80.
- ↑ Cooke & Plotnick. Management of diabetic ketoacidosis in children and adolescents. Pediatr Rev. 2008 Dec;29(12):431-5