Characteristics of Diabetic Ketoacidosis that Increase the Risk of Cerebral Edoema in Children

Abstract

Background: This rare but potentially fatal complication has not yet had its risk factors identified.

Method: A retrospective study of 171 children hospitalised to two hospitals for diabetic ketoacidosis between January 2022 and January 2023 was conducted to analyse the biochemical and therapeutic risk factors for cerebral oedema in this condition. Clinical characteristics, biochemical markers upon presentation, and therapeutic approaches were compared between patients with and without cerebral edoema. From the 171 patients who were part of the research, 15 (8.8%) were found to have cerebral oedema. Just one instance out of seven had a deadly result.       Results: The severe form of diabetic ketoacidosis at presentation, which includes cerebral oedema, is significantly associated with low sodium bicarbonate level, low partial pressure of arterial carbon dioxide (PCO2), high blood glucose (p < 0.01), high blood urea (p < 0.05), and high serum osmolality (p < 0.05). A low level of serum phosphate was significantly associated with cerebral oedema during the treatment of diabetic ketoacidosis (p < 0.05). Brain edoema development was also linked to starting diabetic ketoacidosis treatment before being admitted to our hospital (p < 0.05), taking sodium bicarbonate (p < 0.001), initially receiving a higher volume of fluid (p < 0.01), and delaying potassium substitution (p < 0.01). Conclusions: Children with diabetic ketoacidosis are more likely to develop cerebral oedema if they have a severe case of the condition, high blood sugar and dehydration when they appear, and low serum phosphate levels while they are being treated. Brain damage likely results from early acute acidosis and hyperglycemia; subsequent hypophosphatemia and cerebral hypervolemia create cerebral oedema.