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The risk and outcome of cerebral oedema developing during diabetic ketoacidosis
J A Edge1, M M Hawkins, D L Winter
1Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. julie.edge@paediatrics.ox.ac.uk
Insights
Cerebral oedema is a serious complication of diabetic ketoacidosis (DKA) in children, with a 6.8% risk per 1000 DKA episodes. This condition leads to significant child morbidity and mortality, especially in new-onset diabetes.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Metabolic Disorders
Background:
- Cerebral oedema is a critical cause of mortality and morbidity in children with insulin-dependent diabetes.
- Diabetic ketoacidosis (DKA) is a common and serious complication in pediatric diabetes management.
Purpose of the Study:
- To determine the incidence and outcomes of cerebral oedema in children experiencing DKA.
- To investigate risk factors associated with cerebral oedema development during DKA.
Main Methods:
- A population-based surveillance study across England, Scotland, and Wales.
- Collected data on cerebral oedema cases and DKA episodes from 1995-1998.
- Analyzed risk in relation to diabetes diagnosis status, age, sex, and seasonality.
Main Results:
- Identified 34 cerebral oedema cases among 2940 DKA episodes, yielding a risk of 6.8 per 1000 DKA episodes.
- Risk was significantly higher in new-onset diabetes (11.9/1000) compared to established diabetes (3.8/1000).
- Associated mortality was 24%, with 35% of survivors experiencing significant morbidity.
Conclusions:
- Cerebral oedema remains a significant and dangerous complication of DKA in children.
- The study provides reliable risk estimates, highlighting the increased risk in new-onset diabetes.
- Further research into the etiology of cerebral oedema in DKA is warranted.
Background:
Cerebral oedema is a major cause of morbidity and mortality in children with insulin dependent diabetes.
Aims:
To determine the risk and outcome of cerebral oedema complicating diabetic ketoacidosis (DKA).
Methods:
All cases of cerebral oedema in England, Scotland, and Wales were reported through the British Paediatric Surveillance Unit between October 1995 and September 1998. All episodes of DKA were reported by 225 paediatricians identified as involved in the care of children with diabetes through a separate reporting system between March 1996 and February 1998. Further information about presentation, management, and outcome was requested about the cases of cerebral oedema. The risk of cerebral oedema was investigated in relation to age, sex, seasonality, and whether diabetes was newly or previously diagnosed.
Results:
A total of 34 cases of cerebral oedema and 2940 episodes of DKA were identified. The calculated risk of developing cerebral oedema was 6.8 per 1000 episodes of DKA. This was higher in new (11.9 per 1000 episodes) as opposed to established (3.8 per 1000) diabetes. There was no sex or age difference. Cerebral oedema was associated with a significant mortality (24%) and morbidity (35% of survivors).
Conclusions:
This first large population based study of cerebral oedema complicating DKA has produced risk estimates which are more reliable and less susceptible to bias than those from previous studies. Our study indicates that cerebral oedema remains an important complication of DKA during childhood and is associated with significant morbidity and mortality. Little is known of the aetiology of cerebral oedema in this condition and we are currently undertaking a case control study to address this issue.