Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis

Area of Science:

• Pediatric Endocrinology
• Neurology
• Critical Care Medicine

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
• Cerebral edema is a potentially life-threatening complication of DKA treatment.
• Understanding the predictors and time course of cerebral edema is vital for patient management.

Purpose of the Study:

• To investigate the incidence and timing of cerebral edema in pediatric patients with DKA.
• To identify clinical predictors associated with the development of cerebral edema during DKA.
• To analyze the impact of cerebral edema on patient outcomes, including ICU length of stay.

Main Methods:

• Retrospective review of hospital records for 107 episodes of DKA.
• Data collected between January 2013 and March 2019.
• Analysis of patient demographics, clinical presentation, treatment, and outcomes.

Main Results:

• Cerebral edema was identified in 24.3% of DKA episodes (22 at presentation, 4 during treatment).
• Presentation cerebral edema was linked to lower arterial carbon dioxide, prior fluid treatment, and new-onset diabetes.
• Prior fluid treatment was the sole significant predictor of cerebral edema on multivariate analysis.
• Cerebral edema was associated with a significantly longer ICU stay (4.1 days vs 1.8 days).

Conclusions:

• Cerebral edema is a common occurrence at admission in Indian children with DKA.
• Clinical suspicion for cerebral edema should be heightened in cases of severe metabolic acidosis and prior inappropriate fluid administration.
• Prompt recognition and management are essential to mitigate the adverse effects of cerebral edema in DKA.