Risk Factors for Cerebral Oedema in Children with Diabetic Ketoacidosis

Abstract

Background: The risk factors for this uncommon life-threatening complication haven't been defined clearly yet.

Method: We analyzed the biochemical and therapeutic risk factors for cerebral oedema in diabetic ketoacidosis by a retrospective study of 171 children admitted to two hospitals for diabetic ketoacidosis between January 2022 and January 2023. A comparison was made between the cases with and without cerebral oedema in demographic and biochemical variables at presentation and therapeutic interventions. cerebral oedema was diagnosed in 15 (8.8%) of 171 cases included in the study. The outcome was fatal only in one of these cases (7%).

Results: cerebral oedema had a significant association with the severe type of diabetic ketoacidosis at presentation i.e. low venous pH (p < 0.001), low sodium bicarbonate level (p < 0.001), and low partial pressure of arterial carbon dioxide PCO2 (p < 0.001), high blood glucose (p < 0.01), high blood urea (p < 0.05) and high serum osmolality (р < 0.05). During the treatment of diabetic ketoacidosis, cerebral oedema had a significant association with a low level of serum phosphate (p < 0.05). Development of cerebral oedema was also significantly associated with the initiation of management for diabetic ketoacidosis before hospitalization in our hospital (p < 0.05), treatment with sodium bicarbonate (p < 0.001), higher volume of fluid given initially (p < 0.01) and delay in potassium substitution (p < 0.01).

Conclusions: Severe cases of ketoacidosis, hyperglycemia and dehydration at presentation, and low serum phosphate during treatment are significantly related to cerebral oedema formation in children with diabetic ketoacidosis. The initial severe acidosis and hyperglycemia probably lead to brain injury, which in turn causes cerebral oedema in the course of developing hypophosphatemia and cerebral hypervolemia.