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Diabetic ketoacidosis in the pediatric patient
1Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA.
Insights
Diabetic ketoacidosis (DKA) is a serious complication of Type 1 diabetes. While DKA is common, cerebral edema is a rare but fatal complication, with unclear underlying mechanisms and risk factors.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Neurology
Background:
- Diabetic ketoacidosis (DKA) is a significant cause of illness and death in Type 1 diabetes patients.
- Approximately 25% of new Type 1 diabetes diagnoses present with DKA.
- Poorly controlled pre-existing diabetes is the primary reason for DKA hospitalizations.
Purpose of the Study:
- To review the risk factors associated with cerebral edema in diabetic ketoacidosis.
- To discuss the underlying mechanisms of cerebral edema development.
- To propose a treatment protocol for diabetic ketoacidosis.
Main Methods:
- Literature review of studies on diabetic ketoacidosis and cerebral edema.
- Analysis of risk factors identified in existing research.
- Synthesis of information to propose a treatment protocol.
Main Results:
- Cerebral edema occurs in 1% of pediatric DKA cases but causes 20% of diabetes-related deaths.
- Despite a century of progress, DKA mortality has fallen, but cerebral edema mechanisms remain unclear.
- Specific risk factors for cerebral edema exist, yet no recent incidence reduction has been observed.
Conclusions:
- Diabetic ketoacidosis poses significant risks, particularly cerebral edema, despite advances in diabetes care.
- Further research into the mechanisms and risk factors of cerebral edema is crucial.
- A standardized treatment protocol for DKA may help mitigate risks like cerebral edema.
Abstract:
Diabetic ketoacidosis is the major source of morbidity and mortality in patients with Type I diabetes mellitus. One population-based study noted that approximately 25% of newly diagnosed patients present with diabetic ketoacidosis. Most of those hospitalized with diabetes ketoacidosis, however, are those with poor control of their pre-existing diabetes. Cerebral edema has been found to be present in only 1% of children with diabetic ketoacidosis, but accounts for 20% of all diabetes-related deaths. Although the mortality rate has fallen dramatically over the course of the last century, the underlying mechanisms involved with the development of cerebral edema are still not clear. Several studies have shown specific risk factors to be associated with cerebral edema, but as of yet no reduction in the recent incidence of cerebral edema has been demonstrated. A discussion of these risk factors and a suggested protocol for treating diabetic ketoacidosis are included in this review.