Glaser et al identified risk factors for cerebral edema in a child with diabetic ketoacidosis. These can help identify a child who may require aggressive management to prevent or reverse this complication. The authors are from the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.


Patient selection: age <= 18 years of age with diabetes mellitus


Risk factors associated with cerebral edema:

(1) elevated serum BUN on admission

(2) decreased PaCO2 on admission

(3) administration of sodium bicarbonate

(4) failure of serum sodium to increase during therapy


According to Dunger and Edge, therapy with sodium bicarbonate has decreased over the years and now is only recommended for patients with severe circulatory failure who may decompensate in severe acidosis.


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