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Risk Factors for Cerebral Edema in Pediatric Diabetic Ketoacidosis: a Systematic Review and Meta-Analysis of

Luis Gabriel Rocha1, Rayzha Kruzhkaya Cuellar2, Liuba Alexandra Vargas3

  • 1Clinical Epidemiology Master, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.

Journal of Clinical Research in Pediatric Endocrinology
|July 22, 2026
PubMed

Insights

Cerebral edema in pediatric diabetic ketoacidosis is serious. Bicarbonate use may increase risk, but evidence on other factors like age and diabetes type is uncertain and needs more research.

Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine
  • Neurology

Background:

  • Cerebral edema (CE) is a rare but severe complication of pediatric diabetic ketoacidosis (DKA).
  • Identifying risk factors for CE in pediatric DKA is crucial for prevention and management.
  • Current evidence on risk factors remains uncertain, necessitating a comprehensive review.

Purpose of the Study:

  • To systematically synthesize existing evidence on risk factors associated with the development of cerebral edema in pediatric patients experiencing diabetic ketoacidosis.
  • To provide a clearer understanding of factors that may predispose children to this serious complication.

Main Methods:

  • A systematic literature search was performed across major databases (MEDLINE, EMBASE, LILACS, Cochrane Library) up to January 2025.
  • Included observational studies were assessed for risk of bias using Joanna Briggs Institute tools.
  • Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Main Results:

  • Eleven studies comprising 2,545 patients were analyzed.
  • Bicarbonate administration showed a potential association with CE (OR 4.21, low certainty).
  • Evidence regarding younger age, new-onset type 1 diabetes, severe acidosis/urea, and early fluid volume was very uncertain.

Conclusions:

  • Bicarbonate administration may increase the risk of CE in pediatric DKA, supporting current guidelines against its routine use.
  • Associations between CE and younger age, new-onset diabetes, and severe metabolic presentation require cautious interpretation due to very low certainty evidence.
  • Further prospective studies with standardized definitions and robust confounder adjustment are essential to clarify these associations.
Abstract

Keywords:
Diabetic ketoacidosisbicarbonatesbrain edemarisk factorssystematic review

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