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Risk factors for developing brain herniation during diabetic ketoacidosis

C P Mahoney1, B W Vlcek, M DelAguila

  • 1Department of Pediatric Endocrinology, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.

Pediatric Neurology
|December 2, 1999
PubMed

Insights

Diabetic ketoacidosis (DKA) in children can lead to brain herniation. Severe acidosis and rapid fluid rates increase risk, while controlled hydration prevents it.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Neurology

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
  • Brain herniation is a rare but severe complication of DKA treatment.
  • Identifying risk factors for brain herniation is crucial for patient management.

Purpose of the Study:

  • To investigate the incidence and risk factors of brain herniation in children with DKA.
  • To evaluate the association between initial fluid resuscitation rates and brain herniation.
  • To determine optimal fluid management strategies to prevent DKA-related brain herniation.

Main Methods:

  • Retrospective chart review of children admitted with DKA over 12 years.
  • Analysis of clinical data including blood pH, PCO2, and initial fluid administration rates.
  • Comparison of brain herniation incidence based on acidosis severity and fluid therapy rates.

Main Results:

  • Nine out of 153 children experienced brain herniation.
  • Severe acidosis (pH < 7.1) and hypercapnia (PCO2 < 20 mm Hg) were significant risk factors.
  • Fluid administration exceeding 50 mL/kg in the first 4 hours was associated with increased brain herniation risk.

Conclusions:

  • Maintaining adequate pH and PCO2 levels is vital in DKA management.
  • Aggressive initial fluid resuscitation ( > 50 mL/kg/4h) in severe DKA increases brain herniation risk.
  • Controlled fluid administration is recommended to mitigate DKA-related brain herniation.

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