Evaluation of clinical versus radiological measures in the early diagnosis of cerebral edema in diabetic ketoacidosis

Abstract EN

Cerebral edema (CE) complicating diabetic ketoacidosis (DKA) remains the major cause of morbidity and mortality in children and adolescents with type 1diabetes, but its etiology remains unknown.

The clinician’s decision to intervene is particularly important, since early treatment is critical in preventing neurological demise. Aim of the study: To evaluate the efficacy of brain CT scan versus clinical examination in the early detection of cerebral edema in patients with DKA.

We also aimed to determine the impact of baseline biochemical factors on risk of development of cerebral edema in patients with DKA. Subjects and methods: 30 type 1 diabetic patients with DKA, admitted to the emergency room in the Children& Internal medicine Hospitals of Ain Shams University, were included in this study.

Bedside neurological assessment of cerebral edema and Glasgow coma scale were done.

Brain computed tomograms were done for all patients, and their reports were reviewed.

Results: Nine patients (30%) with DKA developed clinical cerebral edema.

Of those, only 3 (10%) showed radiological evidence of cerebral edema.

Patients who developed cerebral edema had one or more risk factors: young age, rapid decline of random blood sugar, hyponatremia, hyperkalemia, HCO3 < 18, pH < 7 or presented with severe dehydration.

Infection was the most common precipitating factor for DKA attacks.

Complications noted during treatment were hypokalemia (n = 14; 46.6%), hyponatremia (n = 16; 53.3%), hypoglycemia (n = 10; 30.3%), and cerebral edema (n = 9; 30%). Conclusion: CE may occur in the absence of acute changes on brain computed tomograms.

CE in the context of DKA is a clinical, not a radiological diagnosis.

The degree of edema formation during DKA in children was correlated with the degree of dehydration, baseline acidosis, low plasma sodium and higher potassium levels.

These biochemical factors were important predictors of risk of development of cerebral edema.

Early detection of CE at the bedside using an evidence-based protocol permits intervention in time to prevent permanent brain damage.