Treating Cerebral Edema in Diabetic Ketoacidosis: Caveats in Extrapolating From Traumatic Brain Injury'

摘要

When encountering children with diabetic ketoacidosis (DKA), the possibility of DKA-related cerebral edema is usually at the forefront of anticipated worries facing treating clinicians. This is because neither the pathophysiology of cerebral edema is well understood nor are proven treatments for cerebral edema available. Both these gaps force clinicians to rely on either theoretical conceptual frameworks of other neurological diseases or a given body of general knowledge of pharmacological agents to address this devastating complication in DKA. Evidence suggests that an ischemic (1) and/or vasogenic (2) process play a role in the genesis of DKA-related cerebral edema, but details of the time course of these processes are not clear. Thus, clinicians are left with employing treatment strategies in DKA with some level of scientific evidence from other neurological conditions where cerebral edema occurs. In children, the reference disease state is typically traumatic brain injury (TBI).