title: Severe pretreatment cerebral edema in newly diagnosed type 1 diabetes.
abstract: BACKGROUND
  Cerebral edema (CE) is a rare and dangerous complication of diabetic ketoacidosis. In typical cases, it may develop during several hours after the beginning of ketoacidosis therapy. Nevertheless, CE sometimes occurs before the start of any therapy - as for the patient in this report here.
  
  
  METHODS
  We describe a 12-year-old girl with newly diagnosed type 1 diabetes, presenting with severe headache and disorientation. Diabetes-related symptoms were not reported by the family. Clinical investigation revealed signs of meningeal irritation and Kussmaul breathing. In the laboratory, severe ketoacidosis (pH 6.95) and hyperglycemia (blood glucose 20.9 mmmol/l) were found. Cranial computed tomography showed CE. The patient was treated with a very cautious fluid and insulin therapy and recovered within 3 days. MRI after recovery showed normal findings without residuals of CE.
  
  
  CONCLUSIONS
  CE before any treatment of ketoacidosis is a very rare complication of type 1 diabetes. Early diagnosis and effective treatment are extremely important for the patient's outcome and prognosis.
authors.affiliation: Department of Pediatrics, Kinderklinik München Schwabing, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Warncke
authors.forename: Petra
authors.initials: P
authors.lastname: Dressel
authors.forename: Anette-G
authors.initials: AG
authors.lastname: Ziegler
authors.forename: Marc
authors.initials: M
authors.lastname: Steinborn
authors.forename: Walter
authors.initials: W
authors.lastname: Bonfig
authors.forename: Stefan
authors.initials: S
authors.lastname: Burdach
authors.forename: Ilse
authors.initials: I
authors.lastname: Engelsberger
mesh_terms: D000293:Adolescent; D001929:Brain Edema / Q000150:complications*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin