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Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis
W H Hoffman1, J P Locksmith, E M Burton
1Department of Pediatrics, Medical College of Georgia, Augusta 30912, USA.
Insights
Interstitial pulmonary edema is common in children with severe diabetic ketoacidosis, often appearing before treatment. Cautious rehydration and monitoring are recommended for managing this condition.
Area of Science:
- Pediatrics
- Endocrinology
- Radiology
Background:
- Diabetic ketoacidosis (DKA) complications in children are known but not fully understood.
- Clinical research on DKA complications has primarily focused on cerebral edema.
- Interstitial pulmonary edema (IPE) in pediatric DKA remains under-investigated.
Purpose of the Study:
- To investigate the prevalence and clinical course of IPE in pediatric patients with severe DKA.
- To assess the timing and resolution of IPE during DKA treatment.
Main Methods:
- High-resolution computed tomography (HRCT) scans of the lungs were utilized.
- Hounsfield attenuation levels were measured and converted to physical density values.
- Seven pediatric patients with severe DKA and uneventful clinical courses were studied.
Main Results:
- All seven patients exhibited evidence of IPE on initial HRCT scans, taken before insulin and within 1 hour of hydration.
- Six out of seven patients showed increased pulmonary density 6-8 hours into treatment.
- Complete resolution of interstitial changes was observed in all patients by discharge.
Conclusions:
- Subclinical IPE may be a frequent, pre-treatment finding in pediatric severe DKA.
- Findings support cautious rehydration and close monitoring in pediatric DKA management.
- Further research is needed for a comprehensive understanding of DKA-associated IPE pathophysiology.
Abstract:
The acute complications of diabetic ketoacidosis in children and adolescents are well recognized but not completely understood. Clinical studies have focused primarily on brain edema. We have investigated the prevalence and course of interstitial pulmonary edema in patients with severe diabetic ketoacidosis all of whom had uneventful clinical courses. High resolution computed tomography scans of the lungs were analyzed by determining the Hounsfield attenuation level and then converting to physical density values. All seven patients had evidence of interstitial pulmonary edema on the first scan, which was performed within 1 h of hydration and prior to receiving insulin; six of the seven patients had increased pulmonary density 6-8 h into treatment, and all had complete resolution of the interstitial changes at discharge. Our study suggests that subclinical interstitial pulmonary edema may be a frequent occurrence in children and adolescents with severe diabetic ketoacidosis and may very well be present prior to treatment. The study also supports the philosophy of cautious rehydration and the close monitoring of children and adolescents with diabetic ketoacidosis until a more complete understanding of this pathophysiologic event is achieved.