DKA and Cerebral Edema

Which of the following is NOT a risk factor for cerebral edema in diabetic ketoacidosis (DKA)?

A. Elevated blood urea nitrogen

B. Low serum potassium on presentation

C. Treatment with bicarbonate

D. Age < 3 years

E. Failure of serum sodium to rise steadily with correction of hyperglycemia

…an excerpt from The Kaji Review 


Patients in DKA may present with hypo-, eu-, or hyperkalemia. Cerebral edema is the most serious immediate risk to the child in DKA, occurring in 1% of cases. The presentation can include altered mental status, focal neurologic deficits, and abnormal respiratory pattern. The mortality of cerebral edema is 25%, and of those who survive, 25% will have significant morbidity. Treatment includes airway management and mannitol 1 g/kg IV given over 10 minutes. Patients should be admitted to an intensive care unit. Despite multiple investigations and changes in the therapy of DKA, the incidence of cerebral edema has not changed in the past two decades. Risk factors for cerebral edema in DKA are:

  • Elevated BUN
  • Low pCO2
  • Treatment with bicarbonate
  • Failure of measured serum sodium to rise steadily with correction of hyperglycemia
  • Age < 3 years
  • New-onset diabetes


  • Marcin JP, et al. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Journal of Pediatrics. 2002; 141(6): 793-797.

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