FACTORS ASSOCIATED WITH BRAIN HERNIATION IN THE TREATMENT OF DIABETIC-KETOACIDOSIS

To determine factors contributing to life-threatening brain herniation in patients treated for severe diabetic ketoacidosis, we analyzed history, laboratory data, rate and composition of fluid and insulin administration, and time to onset of brain herniation in nine new cases and 33 prior reports. The overall rate of fluid administration was inversely correlated with the time of onset of hernation (r = -0.32, p = 0.04). Only 4 of 40 cases occurred at fluid intakes .ltoreq. 4.0 L/m2/day. During treatment, "calculated" serum sodium concentrations fell significantly and were < 130 mEq/L in 33% of cases at the time of herniation. These data indicate that excessive secretion of vasopressin may exacerbate the brain edema, and that limitation of the rate of fluid administration may be prudent.