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Hyperglycemic crises and their complications in children
1Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Children's Medical Services Center, 1701 SW 16th Avenue, Gainesville 32608, USA. rosenal@peds.ufl.edu
Journal of Pediatric Endocrinology & Metabolism : JPEM
|February 24, 2007
Summary
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are serious diabetes complications. Cerebral edema is a key mortality cause, with early detection and careful treatment crucial for better outcomes.
Area of Science:
- Endocrinology and Metabolism
- Diabetology
- Critical Care Medicine
Background:
- Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are acute, life-threatening complications of diabetes mellitus.
- These conditions present significant challenges in diagnosis, management, and prevention of long-term disability or mortality.
- Cerebral edema is a particularly dangerous complication, accounting for a substantial portion of DKA-related deaths.
Purpose of the Study:
- To define criteria for DKA and HHS.
- To review current knowledge on causes of mortality and disability from DKA/HHS complications.
- To identify risk factors, early indicators, and contemporary treatment strategies for DKA/HHS, focusing on cerebral edema.
Main Methods:
- Comprehensive literature review of definitions, risk factors, and complications of DKA and HHS.
- Analysis of studies on the incidence, risk factors, and treatment of cerebral edema in DKA.
- Evaluation of proposed monitoring methods and treatment interventions for cerebral edema.
Main Results:
- DKA occurs at onset in 10-70% of type 1 DM and 5-52% of type 2 DM; HHS occurs in ~4% of new type 2 DM patients.
- Recurrent DKA rates are high, influenced by healthcare access and socioeconomic factors.
- Cerebral edema is a major cause of DKA mortality (2/3+), with incidence of 0.5-2.0%; risk factors include younger age, severe acidosis, hypocapnia, and dehydration. Vasogenic edema is the likely mechanism.
- Aggressive hyperventilation may adversely affect outcomes in cerebral edema treatment.
Conclusions:
- Preventing DKA/HHS at diabetes onset requires high provider awareness.
- Preventing recurrent DKA necessitates a diligent, team-based approach.
- Early detection and cautious management of cerebral edema are critical for improving patient outcomes.
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