Preventing a Drop in Effective Plasma Osmolality to Minimize the Likelihood of Cerebral Edema During Treatment of Children with Diabetic Ketoacidosis - 12/08/11
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, Ana P.C.P. Carlotti, MD †, Leila A.A. Costa, MD †, Beth MacMahon, MB ‡, Gareth Bohn, BSc ‡, Robert Zietse, MD , Mitchell L. Halperin, MD §, Desmond Bohn, MB ‡, 
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands Department of Anesthesia, University of Toronto, Toronto, Canada. Reprint requests: Ewout J. Hoorn, MD, Dr Molewaterplein 40, Room Bd 391, 3015 GD Rotterdam, The Netherlands.Résumé |
Objectives |
To test whether a drop in effective plasma osmolality (PEff osm; 2 × plasma sodium [PNa] + plasma glucose concentrations) during therapy for diabetic ketoacidosis (DKA) is associated with an increased risk of cerebral edema (CE), and whether the development of hypernatremia to prevent a drop in the PEff osm is dangerous.
Study design |
This study is a retrospective comparison of a CE group (n = 12) and non-CE groups with hypernatremia (n = 44) and without hypernatremia (n = 13).
Results |
The development of CE (at 6.8 ± 1.5 hours) was associated with a drop in PEff osm from 304 ± 5 to 290 ± 5 mOsm/kg (P < .001). Control patients did not show this drop in PEff osm at 4 hours (1 ± 2 and 2 ± 2 vs –9 ± 2 mOsm/kg; P < .01), because of a larger rise in PNa and/or a smaller drop in plasma glucose. During this period, the CE group received more near-isotonic fluids (69 ± 9 vs 35 ± 2 and 27 ± 3 mL/kg; P < .001). The CE group had a higher mortality (3/12 vs 0/57; P = .003), and more neurologic sequelae (5/12 vs 1/57; P < .001).
Conclusions |
CE during therapy for DKA was associated with a drop in PEff osm. An adequate rise in PNa may be needed to prevent this drop in PEff osm.
Le texte complet de cet article est disponible en PDF.Abbreviations : ANOVA, CE, CT, DKA, HSC, ICU, IV, PEff osm, PGlucose, PNa, USP
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Vol 150 - N° 5
P. 467-473 - mai 2007 Retour au numéro
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