Neurological Status Deterioration in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
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Pediatrics in South America (L Landry, Section Editor)
Neurological Status Deterioration in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State Zuazaga Marcela, MD* Fustin˜ana Ana, MD Pellegrini Solana, MD Arpi Lucrecia, MD Prieto Mariana, MD Martinez Mateu Carolina, MD Krochik Gabriela, MD Address * Interdisciplinary Working Group on Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State Standards, Hospital de Pediatria J. P. Garrahan, Buenos Aires, Argentina Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Pediatrics in South America Keywords Diabetic ketoacidosis I Cerebral edema I Hyperosmolar hyperglycemic state
Abstract Purpose of review To emphasize the pathophysiological and therapeutic approach differences between diabetic ketoacidosis (DK) and hyperosmolar hyperglycemic state (HHS). Recent findings This manuscript depicts the different therapeutic protocols and potential complications in DK and HHS based on the best current evidence, in order to improve their management. Novel studies show quite different fluid management between DK and HHS, encouraging bicarbonate avoidance whenever possible. Summary Diabetic ketoacidosis is one of the most severe and life-threatening complications in diabetes. Cerebral edema may sometimes appear (less than 1%) as a consequence of DK, and it carries out high morbidity (serious neurocognitive sequelae) and mortality itself. The younger the patient, the higher the risk for developing CE, especially in recently diagnosed patients. This life-threatening complication must be clinically suspected in
Pediatrics in South America (L Landry, Section Editor) front of a patient undergoing a DK episode, and treatment should be started as soon as possible. Other diabetic patients may decompensate with an HHS, which is pathophysiologically different from DK. Indeed patients with DK complication must have a cautious fluid management. On the contrary, HHS should be treated with an aggressive fluid reposition. Pediatric patients undergoing severe DK or HSS should to be admitted to a PICU for monitoring and especial care.
Cerebral edema (CE) in diabetic ketoacidosis (DK) Diabetic ketoacidosis (DK), which is caused by a relative or absolute insulin deficiency, is the most severe and life-threatening complication of diabetes. This clinical presentation has a frequency that ranges between 15 and 60% of patients [1••]. In the known diabetic patients, DK is usually the result of insufficient insulin due to missing doses or otherwise triggered by an acute illness. Severe complications may occur in pediatric patients who suffer a DK episode, being cerebral edema (CE) the worst one, carrying a high morbidity and mortality. Though its incidence is less than 1%, CE may cause serious neurocognitive sequelae. Multiple pathophysiological mechanisms, including vasogenic and/or cytotoxic mechanisms, have been proposed for CE development [2, 3]. Several studies evaluated the association between CE and rapid fluid admi
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