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Risk Factors for Cerebral Edema and Acute Kidney Injury in Children with Diabetic Ketoacidosis
Veena Raghunathan1, Ganesh Jevalikar2, Maninder Dhaliwal3
1Medanta-The Medicity, Gurugram, Haryana, India.
Insights
Diabetic ketoacidosis (DKA) in children can lead to cerebral edema and acute kidney injury. Higher urea and corrected sodium, with lower bicarbonate levels at admission, predict cerebral edema risk.
Area of Science:
- Pediatric Intensive Care Medicine
- Endocrinology
- Nephrology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus in children.
- Cerebral edema and acute kidney injury (AKI) are significant concerns in pediatric DKA management.
- Identifying risk factors is crucial for timely intervention and improved outcomes.
Observation:
- A retrospective review analyzed 50 DKA episodes in pediatric patients (<18 years).
- Cerebral edema occurred in 22% and AKI in 30% of cases.
- Key biochemical markers at admission were assessed for correlation with complications.
Findings:
- Higher blood urea levels, lower serum bicarbonate, and higher corrected sodium at admission were independently associated with an increased risk of cerebral edema.
- These factors, along with the severity of dehydration and acidosis, appear to contribute to both brain and kidney dysfunction.
Implications:
- Early identification of these biochemical predictors can aid in risk stratification for cerebral edema in pediatric DKA.
- Understanding these risk factors can guide proactive management strategies to prevent severe complications.
- This research highlights the interconnectedness of metabolic derangements and organ dysfunction in DKA.
Objectives:
To study the clinical profile and risk factors of cerebral edema and acute kidney injury in children with diabetic ketoacidosis.
Design:
Retrospective review of medical records.
Patients:
Fifty consecutive patients (age <18 years) admitted to our pediatric intensive care unit with a diagnosis of diabetic ketoacidosis over 5 years.
Materials And Methods:
Retrospective analysis of medical records was done, and data including patients' age, sex, presenting features, biochemical profile including blood glucose, osmolality, urea, creatinine, and venous blood gas, electrolytes were recorded at admission, at 12 and 24 hours. Treatment details including fluid administration, rate of fall of glucose, time to resolution of diabetic ketoacidosis were noted. Complications such as cerebral edema and acute kidney injury were recorded. Patients with and without cerebral edema and acute kidney injury were compared. Variables that were significant on univariate analysis were entered in a multiple logistic regression analysis to determine the independent predictors for cerebral edema and acute kidney injury. Odds ratio and 95% confidence interval were calculated using SPSS version 22.
Measurements And Main Results:
Between November 2015 and 2020, 48 patients were admitted for a total of 50 episodes of diabetic ketoacidosis. Two patients had recurrent diabetic ketoacidosis. Median age was 9.5 years (range 1-17). Thirty-one patients (62%) had new-onset type I diabetes mellitus. Twenty-two patients (44%) presented with severe diabetic ketoacidosis. Cerebral edema and acute kidney injury were seen in 11 (22%) and 15 (30%) patients, respectively. On multiple logistic regression analysis, higher blood urea level, lower serum bicarbonate level, and higher corrected sodium levels at admission were identified to be variables independently associated with risk of cerebral edema.
Conclusions:
Higher corrected sodium, higher urea level, and lower serum bicarbonate levels at admission are predictive of cerebral edema in patients presenting with diabetic ketoacidosis. The severity of dehydration and acidosis in DKA appears to be a common factor responsible for the development of dysfunction of both brain and kidney.
How To Cite This Article:
Raghunathan V, Jevalikar G, Dhaliwal M, Singh D, Sethi SK, Kaur P, et al. Risk Factors for Cerebral Edema and Acute Kidney Injury in Children with Diabetic Ketoacidosis. Indian J Crit Care Med 2021;25(12):1446-1451.
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