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Cerebral edema in diabetic ketoacidosis

Levin, Daniel L. MD, FAAP, FCCM, FACC

Pediatric Critical Care Medicine: May 2008 - Volume 9 - Issue 3 - p 320-329
doi: 10.1097/PCC.0b013e31816c7082
Review Article

Objective: To review the causes of cerebral edema in diabetic ketoacidosis (CEDKA), including pathophysiology, risk factors, and proposed mechanisms, to review the diagnosis, treatment, and prognosis of CEDKA and the treatment of diabetic ketoacidosis as it pertains to prevention of cerebral edema.

Data Source: A MEDLINE search using OVID was done through 2006 using the search terms cerebral edema and diabetic ketoacidosis.

Results of Search: There were 191 citations identified, of which 150 were used. An additional 42 references listed in publications thus identified were also reviewed, and two book chapters were used.

Study Selection: The citations were reviewed by the author. All citations identified were used except 25 in foreign languages and 16 that were duplicates or had inappropriate titles and/or subject matter. Of the 194 references, there were 21 preclinical and 40 clinical studies, 35 reviews, 15 editorials, 43 case reports, 29 letters, three abstracts, six commentaries, and two book chapters.

Data Synthesis: The data are summarized in discussion.

Conclusions: The causes and mechanisms of CEDKA are unknown. CEDKA may be due as much to individual biological variance as to severity of underlying metabolic derangement of the child's state and/or treatment risk factors. Treatment recommendations for CEDKA and diabetic ketoacidosis are made taking into consideration possible mechanisms and risk factors but are intended as general guidelines only in view of the absence of conclusive evidence.

From Dartmouth Medical School, Lebanon, NH.

Supported, in part, by the Susan J. Epply Quasi-Endowment Fund, Pediatric Critical Care, Children's Hospital at Dartmouth.

The author has not disclosed any potential conflicts of interest.

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Cerebral edema in diabetic ketoacidosis: Erratum

In the article that appeared on page 320 of the May 2008 issue, the author produced an error. On page 323, Col 1, paragraph 2, 5 lines from the end of the paragraph, it states, “Interleukin-10 is elevated as well, increasing at the time of symptomatic CE (112).” It should state, “Interleukin-10 is elevated as well, decreasing at the time of symptomatic CE (112).”

This erratum is published in the May 2009 issue of the journal.

©2008The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies