Protracted Hypercapnia as an Important Risk Factor in the Origin of Brain Edema in theCourse of Diabetic Ketoacidosis in Children

Overview

Introduction:
Brain edema is a rare, but feared complication of diabetic ketoacidosis (DKA) with highmortalityand morbidity. Pathogenesis of the origin of brain edema is still uncertain and risk factors, which ensue in thissevere complication, are not precisely defined.Methods: In the retrospective study the authors followed the frequency of occurrence of DKA and brain edemain children with diabetesmellitus of 1st type(DM1) in the period of January 1999 to June 2002. Risk factors involvedin the development of brain edema were evaluated.Results: The criteria for DKA were fulfilled in 27 out of 101 children admitted for DM1, the diagnosis wasestablished in 24 new patients. Clinical findings in four newly diagnosed patients corresponded to the establisheddiagnosis of brain edema. All four patients with brain edema were transferred to their district children’s wardafter 4 to 27 hours after admission. The values of pH and pCO2 in blood were lower in patients with brain edemathan the mean values in other 23 children with DKA. The duration of Kussmaul’s breathing was markedly longerin patients with brain edema and corresponded to the duration of severe metabolic acidosis. Their mean age didnot differ from other children with DKA. Blood levels of urea were comparable in both groups.None of the patientsdied during hospitalization.Conclusion: The duration of severe metabolic acidosis, hypocapnia and DKA as the first manifestation of DM1were evaluated as risk factors for the development of brain edema in the course of DKA at the child age inaccordance with present data in literature.

Key words:
diabetes mellitus, diabetic ketoacidosis, brain edema, hypocapnia