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Cerebral edema in children with diabetic ketoacidosis

Morey W Haymond, MD
Section Editors
Joseph I Wolfsdorf, MB, BCh
Adrienne G Randolph, MD, MSc
Deputy Editor
Alison G Hoppin, MD


Cerebral edema (or cerebral injury) is an uncommon but potentially devastating consequence of diabetic ketoacidosis (DKA). It is far more common among children with DKA than among adults. Young children and those with newly diagnosed diabetes are at highest risk. Symptoms typically emerge during treatment for DKA, but may be present prior to initiation of therapy.

The pathophysiology, diagnosis, and treatment of cerebral edema in children with DKA will be discussed here. The diagnosis and treatment of DKA in children is discussed separately. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Treatment and complications of diabetic ketoacidosis in children and adolescents".)


Clinically significant cerebral edema occurs in approximately 1 percent of episodes of DKA in children and has a mortality rate of 20 to 90 percent [1-3]. Overall mortality rates for diabetic ketoacidosis (DKA) in children and adolescents range from 0.15 to 0.51 percent in national population studies in Canada, the United Kingdom, and the United States [4-9]; 50 to 80 percent of diabetes-related deaths are caused by cerebral edema [1,2,10]. Other causes of death from DKA include aspiration pneumonia, multiple organ failure, gastric perforation, and traumatic hydrothorax [5].

Subclinical brain swelling, as detected by ventricular narrowing on a computed tomography (CT) scan, has been reported in the majority of children with DKA in some studies [11,12], while others reported much smaller proportions [13]. All of these studies were limited by small numbers and lack of appropriate control groups.

In a study of 41 children with DKA, the intercaudate width of the frontal horns of the lateral ventricles was measured by magnetic resonance imaging (MRI) [14]. The lateral ventricles were significantly smaller in patients during treatment for DKA than after recovery (mean width 9.3±0.3 versus 10.2±0.3 mm, respectively). Fifty-six percent of the children had ventricular narrowing during treatment, and these children were more likely to have mental status changes than those without narrowed ventricles (Glasgow coma scale [GCS] scores below 15 occurred in 12 of 22 with ventricular narrowing, versus 4 of 19 without).

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Literature review current through: Nov 2017. | This topic last updated: Jun 01, 2017.
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