title: Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis.
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.
authors.affiliation: Department of Pediatrics, Medical College of Georgia, Augusta 30912, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Hoffman
authors.forename: J P
authors.initials: JP
authors.lastname: Locksmith
authors.forename: E M
authors.initials: EM
authors.lastname: Burton
authors.forename: E
authors.initials: E
authors.lastname: Hobbs
authors.forename: G G
authors.initials: GG
authors.lastname: Passmore
authors.forename: A L
authors.initials: AL
authors.lastname: Pearson-Shaver
authors.forename: D A
authors.initials: DA
authors.lastname: Deane
authors.forename: M
authors.initials: M
authors.lastname: Beaudreau
authors.forename: R W
authors.initials: RW
authors.lastname: Bassali
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D016883:Diabetic Ketoacidosis / Q000150:complications*; D004573:Electrolytes / Q000097:blood; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D010100:Oxygen / Q000097:blood; D015995:Prevalence; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013902:Radiography, Thoracic; D012044:Regression Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose; D004573:Electrolytes; D002245:Carbon Dioxide; D010100:Oxygen