Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema.
OBJECTIVE
To investigate the relation between outcomes of children with diabetic ketoacidosis (DKA)-related cerebral edema and baseline clinical features and therapeutic interventions for treatment of cerebral edema.


METHODS
All children </=18 years old with DKA and cerebral edema (n = 61) were retrospectively identified from 10 pediatric centers between 1982 and 1997. Demographic, biochemical, and therapeutic data were collected. Ordinal logistic regression analysis was used to identify factors associated with the clinical outcome (death or persistent vegetative state; mild to moderate neurological disability; or normal) after adjusting for known risk factors for the development of cerebral edema as well as the degree of neurologic depression at the time of diagnosis of cerebral edema.


RESULTS
Seventeen (28%) children died or survived in a vegetative state; 8 (13%) survived with mild to moderate neurologic disabilities; and 36 (59%) survived without sequelae. Factors associated with poor outcomes included greater neurologic depression at the time of diagnosis of cerebral edema, a high initial serum urea nitrogen concentration, and intubation with hyperventilation to a PCO (2) <22 mm Hg.


CONCLUSIONS
After adjusting for potential confounding variables and the degree of neurologic compromise at the initiation of therapy, intubation with hyperventilation is associated with adverse outcomes of DKA-related cerebral edema. Greater neurologic depression at the time of diagnosis of cerebral edema and a higher initial serum urea nitrogen concentration are also associated with poor outcome.
Marcin
James P
JP
Department of Pediatrics and the Division of Emergency Medicine, University of California, Davis, School of Medicine, Davis, USA.
Glaser
Nicole
N
Barnett
Peter
P
McCaslin
Ian
I
Nelson
David
D
Trainor
Jennifer
J
Louie
Jeffrey
J
Kaufman
Francine
F
Quayle
Kimberly
K
Roback
Mark
M
Malley
Richard
R
Kuppermann
Nathan
N
D000293:Adolescent; D001929:Brain Edema / Q000209:etiology* / Q000628:therapy; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis