Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis

Objectives To determine incidence, outcomes, and risk factors for pediatric cerebral edema with diabetic ketoacidosis (CEDKA) in Canada. Study design This was a case-control study nested within a population-based active surveillance study of CEDKA in Canada from July 1999 to June 2001. Cases are patients with DKA < 16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema. Results Thirteen cases of CEDKA were identified over the surveillance period for an incidence rate of 0.51%; 23% died and 15% survived with neurologic sequelae. CEDKA was present at initial presentation of DKA in 19% of cases. CEDKA was associated with lower initial bicarbonate (P =.001), higher initial urea (P =.001), and higher glucose at presentation (P = .014). Although there was a trend to association with higher fluid rates and treatment with bicarbonate, these were not independent predictors. Conclusions CEDKA remains a significant problem with a high mortality rate. No association was found between the occurrence of CEDKA and treatment factors. The presence of cerebral edema before treatment of DKA and the association with severity of illness suggest that prevention of DKA is the key to avoiding this devastating complication.