Complication Of Diabetic Ketoacidosis Research Articles

Cerebral Oedema Complicating Diabetic Ketoacidosis

Four children presented with cerebral oedema secondary to diabetic ketoacidosis, each of whom had a different clinical picture and time of onset of neurological deterioration. No single factor emerged as the cause of the cerebral oedema, but disturbances in brain water balance appeared to be already operative at the time of presentation with ketoacidosis. Irregularities in treatment may exacerbate these disturbances, leading to frank cerebral oedema. Diagnosis of this dangerous complication of diabetic ketoacidosis depends on clinical awareness; the diagnosis may be confirmed by CT scan. Management remains empirical.

USE OF AN INTRACRANIAL PRESSURE MONITOR IN CEREBRAL EDEMA COMPLICATING DIABETIC KETOACICOSIS

Cerebral edema(CE) is a frequently fatal complication of diabetic ketoacidosis(DKA) in children. We describe the use of an intracranial pressure(ICP) monitor in the management of CE in a 3 year old girl with DKA who was successfully treated for glucose and electrolyte derangements by conventional fluid therapy and IV low-dose insulin, but deteriorated neurologically. She became comatose, bradycardic, and hypertensive. Head CT disclosed CE and an ICP monitor was placed. She was treated by fluid restriction and received 5 infusions of mannitol(300mg/kg/dose) for ICP>20 torr not relieved by sedation, which were followed by rapid improvement in clinical status and ICP. The mean change in ICP in the hour after mannitol was -10.7 torr(range -4 to -21). The patient recovered without neurological sequelae. Interestingly, clinical signs did not adequately predict when ICP was dangerously high. Although the correlation between Glasgow coma score (3-deepest coma, 15-normal) and ICP was statistically significant (r=-.52, p<.01), a score of 7, for example, was associated with ICPs ranging from 10 to 30 torr. Neither pulse nor BP was a clinically or statistically significant predictor of ICP(r=.29, p> 0.1;r=.12, p>0.1, respectively). Since the pathogenesis and therapy of this lethal condition are controversial, and our data indicate that clinical signs are inadequate predictors of elevated ICP, the use of an ICP monitor can reduce uncertainty when managing this complication of DKA.

Mucormycosis in Renal Transplant Patients - A Report of Two Cases and Review of the Literature

Mucormycosis is a rare complication of diabetic ketoacidosis and immunosuppressed states, such as those occurring after renal transplantation. We describe two cases of mucormycosis in renal allograft recipients and present a review of similar cases previously reported. An analysis of these data suggests that renal transplant patients with concomitant diabetes mellitus are most susceptible to developing this complication.