Cerebral Oedema in Diabetic Ketoacidosis (DKA)
Description Diagnostic criteria General and supportive measures Medicine treatment ICD-10 Code: G93.6 DESCRIPTION A condition of brain swelling during the course of treatment for DKA. Cerebral oedema usually occurs 4–12 hours after the initiation of treatment, but may be present at the time of diagnosis. It often follows an initial period of clinical and biochemical improvement. Cerebral oedema c
General and supportive measures
ICD-10 Code: G93.6
DESCRIPTION
A condition of brain swelling during the course of treatment for DKA.
Cerebral oedema usually occurs 4–12 hours after the initiation of treatment, but may be present at the time of diagnosis. It often follows an initial period of clinical and biochemical improvement.
Cerebral oedema causes significant neurological morbidity and has a mortality of approximately 80%.
The cause of cerebral oedema during treatment remains unclear. However, very rapid reduction in intravascular osmolality may aggravate the process. Therefore, rehydration should occur more slowly in children with DKA than in other causes of dehydration.
DIAGNOSTIC CRITERIA
Clinical
- Signs and symptoms of cerebral oedema include:
- headache,
- confusion,
- irritability and restlessness,
- reduced consciousness,
- papilloedema (late sign),
- hypoxaemia, and
- specific neurological signs and raised intracranial pressure.
- The risk of cerebral oedema is increased if urea levels are increased or if the PCO2 is persistently low, i.e. < 20 mmHg (2.7 kPa).
GENERAL AND SUPPORTIVE MEASURES
- Admit to ICU, if possible, or to a centre experienced with managing this condition.
- Restrict intravenous fluids to ⅔ maintenance and replace deficit over 72 hours rather than 48 hours pending ICU admission.
- Elevate the head of bed.
- Exclude hypoglycaemia.
- Do not use bicarbonate.
- Exclude thrombosis, intracranial haemorrhage or infection.
- Do not delay treatment while waiting for a CT scan to confirm cerebral oedema.
MEDICINE TREATMENT
For the management of cerebral oedema, see : Status Epilepticus (convulsive), cerebral oedema.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 7: Endocrine, 7.5 Diabetes Mellitus, 7.5.2.1 Cerebral Oedema In Diabetic Ketoacidosis (DKA)