Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema

James P. Marcin, Nicole Glaser, Peter Barnett, Ian McCaslin, David Nelson, Jennifer Trainor, Jeffrey Louie, Francine Kaufman, Kimberly Quayle, Mark Roback, Richard Malley, Nathan Kuppermann

Research output: Contribution to journalArticle

101 Scopus citations

Abstract

Objective: To investigate the relation between outcomes of children with diabetic ketoacidosis (DKA)-related cerebral edema and baseline clinical features and therapeutic interventions for treatment of cerebral edema. Study design: All children ≤18 years old with DKA and cerebral edema (n = 61) were retrospectively identified from 10 pediatric centers between 1982 and 1997. Demographic, biochemical, and therapeutic data were collected. Ordinal logistic regression analysis was used to identify factors associated with the clinical outcome (death or persistent vegetative state; mild to moderate neurological disability; or normal) after adjusting for known risk factors for the development of cerebral edema as well as the degree of neurologic depression at the time of diagnosis of cerebral edema. Results: Seventeen (28%) children died or survived in a vegetative state; 8 (13%) survived with mild to moderate neurologic disabilities; and 36 (59%) survived without sequelae. Factors associated with poor outcomes included greater neurologic depression at the time of diagnosis of cerebral edema, a high initial serum urea nitrogen concentration, and intubation with hyperventilation to a PCO2 <22 mm Hg. Conclusions: After adjusting for potential confounding variables and the degree of neurologic compromise at the initiation of therapy, intubation with hyperventilation is associated with adverse outcomes of DKA-related cerebral edema. Greater neurologic depression at the time of diagnosis of cerebral edema and a higher initial serum urea nitrogen concentration are also associated with poor outcome.

Original languageEnglish
Pages (from-to)793-797
Number of pages5
JournalJournal of Pediatrics
Volume141
Issue number6
DOIs
StatePublished - Dec 1 2002

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    Marcin, J. P., Glaser, N., Barnett, P., McCaslin, I., Nelson, D., Trainor, J., Louie, J., Kaufman, F., Quayle, K., Roback, M., Malley, R., & Kuppermann, N. (2002). Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Journal of Pediatrics, 141(6), 793-797. https://doi.org/10.1067/mpd.2002.128888