Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification.
OBJECTIVE
Children who develop cerebral edema (CE) during diabetic ketoacidosis (DKA) exhibit definable signs and symptoms of neurological collapse early enough to allow intervention to prevent brain damage. Our objective was to develop a model for early detection of CE in children with DKA.


METHODS
A training sample of 26 occurrences of DKA complicated by severe CE and 69 episodes of uncomplicated DKA was reviewed. Signs of neurological disease were incorporated into a bedside evaluation protocol that was applied to an independent test sample of 17 patients previously reported to have developed symptomatic CE during treatment for DKA. Head computed tomograms and their reports were reviewed.


RESULTS
The protocol allowed 92% sensitivity and 96% specificity for the recognition of CE sufficiently early for intervention. The diagnostic criteria were fulfilled in two temporal patterns, defining early- and late-onset CE. Although initial computed tomograms were often normal, the findings also included diffuse CE and focal brain injury, the latter only in patients with an early onset of abnormal neurological signs.


CONCLUSIONS
CE may occur in the absence of acute changes on head computed tomograms. Early detection of CE at the bedside using an evidence-based protocol permits intervention in time to prevent permanent brain damage.
Muir
Andrew B
AB
Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA. amuir@mcg.edu
Quisling
Ronald G
RG
Yang
Mark C K
MC
Rosenbloom
Arlan L
AL
D000293:Adolescent; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D016883:Diabetic Ketoacidosis / Q000150:complications*; D003929:Diabetic Neuropathies / Q000145:classification / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity