title: Preventing a drop in effective plasma osmolality to minimize the likelihood of cerebral edema during treatment of children with diabetic ketoacidosis.
abstract: OBJECTIVE
  To test whether a drop in effective plasma osmolality (P(Eff osm); 2 x plasma sodium [P(Na)] + plasma glucose concentrations) during therapy for diabetic ketoacidosis (DKA) is associated with an increased risk of cerebral edema (CE), and whether the development of hypernatremia to prevent a drop in the P(Eff osm) is dangerous.
  
  
  METHODS
  This study is a retrospective comparison of a CE group (n = 12) and non-CE groups with hypernatremia (n = 44) and without hypernatremia (n = 13).
  
  
  RESULTS
  The development of CE (at 6.8 +/- 1.5 hours) was associated with a drop in P(Eff osm) from 304 +/- 5 to 290 +/- 5 mOsm/kg (P < .001). Control patients did not show this drop in P(Eff osm) at 4 hours (1 +/- 2 and 2 +/- 2 vs -9 +/- 2 mOsm/kg; P < .01), because of a larger rise in P(Na) and/or a smaller drop in plasma glucose. During this period, the CE group received more near-isotonic fluids (69 +/- 9 vs 35 +/- 2 and 27 +/- 3 mL/kg; P < .001). The CE group had a higher mortality (3/12 vs 0/57; P = .003), and more neurologic sequelae (5/12 vs 1/57; P < .001).
  
  
  CONCLUSIONS
  CE during therapy for DKA was associated with a drop in P(Eff osm). An adequate rise in P(Na) may be needed to prevent this drop in P(Eff osm).
authors: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. ejhoorn@gmail.com
authors: Ewout J
authors: EJ
authors: Hoorn
authors: Ana P C P
authors: AP
authors: Carlotti
authors: Leila A A
authors: LA
authors: Costa
authors: Beth
authors: B
authors: MacMahon
authors: Gareth
authors: G
authors: Bohn
authors: Robert
authors: R
authors: Zietse
authors: Mitchell L
authors: ML
authors: Halperin
authors: Desmond
authors: D
authors: Bohn
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D001929:Brain Edema / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000209:etiology; D008297:Male; D009994:Osmolar Concentration; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood
chemical_list: D001786:Blood Glucose; D012964:Sodium