Abstract
Background: Diabetic ketoacidosis (DKA) is a common initial presentation of pediatric type 1 diabetes mellitus. Intracerebral complications of DKA pose significant mortality and morbidity rates.
Objective: Our aim is to emphasize the importance of early identification, investigation, and treatment for patients who present with DKA and stroke.
Case report: Here, we report a case of a 4-year-old female patient who presented with ischemic-hemorrhagic stroke as a complication of DKA.
Conclusion: Cerebrovascular complications of DKA in children are a rare condition; however, higher risks take place in their youngest age. Clinicians should be aware of these complications so as to develop appropriate approach for its management.
References
1. Foster JR, Morrison G, Fraser DD. Diabetic ketoacidosis-associated stroke in children and youth. Stroke Res Treat 2011;2011:219706.10.4061/2011/219706Suche in Google Scholar
2. Roe TF, Crawford TO, Huff KR, Costin G, Kaufman FR, et al. Brain infarction in children with diabetic ketoacidosis. J Diabetes Complicat 1996;10:100–8.10.1016/1056-8727(94)00058-1Suche in Google Scholar
3. Ho J, Pacaud D, Hill MD, Ross C, Hamiwka L, et al. Diabetic ketoacidosis and pediatric stroke. Can Med Assoc J 2005;172:327–28.10.1503/cmaj.1032013Suche in Google Scholar PubMed PubMed Central
4. Siqueira LF. Cerebrovascular complications of diabetic ketoacidosis in children. Arq Bras Endocrinol Metabol 2011;55:288–90.10.1590/S0004-27302011000400009Suche in Google Scholar
5. Petzold S, Kapellen T, Siekmeyer M, Hirsch W, Bartelt H, et al. Acute cerebral infarction and extra pontine myelinolysis in children with new onset type 1 diabetes mellitus. Pediatr Diabetes 2011;12:513–17.10.1111/j.1399-5448.2010.00732.xSuche in Google Scholar PubMed
6. Edge JA, Hawkins MM, Winter DL, Dunger DB. The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 2001;85:16–22.10.1136/adc.85.1.16Suche in Google Scholar PubMed PubMed Central
7. Rosenbloom AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 1990;13:22–33.10.2337/diacare.13.1.22Suche in Google Scholar PubMed
8. Lin JJ, Lin KL, Wang HS, Wong AM, Hsia SH. Occult infarct with acute hemorrhagic stroke in juvenile diabetic ketoacidosis. Brain Dev 2008;30:91–3.10.1016/j.braindev.2007.06.001Suche in Google Scholar PubMed
9. Jain SK, McVie R, Bocchini JA Jr. Hyperketonemia (ketosis), oxidative stress and type 1 diabetes. Pathophysiology 2006;13:163–70.10.1016/j.pathophys.2006.05.005Suche in Google Scholar PubMed
10. Carl GF, Hoffman WH, Passmore GG, Truemper EJ, Lightsey AL, et al. Diabetic ketoacidosis promotes a prothrombotic state. Endocr Res 2003;29:73–82.10.1081/ERC-120018678Suche in Google Scholar
11. Ileri NS, Büyükasik Y, Karaahmetoğlu S, Ozatli D, Sayinalp N, et al. Evaluation of the haemostatic system during ketoacidotic deterioration of diabetes mellitus. Haemostasis 1999;29:318–25.Suche in Google Scholar
12. Ho J, Mah JK, Hill MD, Pacaud D. Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature. Pediatr Diabetes 2006;7:116–21.10.1111/j.1399-543X.2006.00151.xSuche in Google Scholar
13. Evan-Wong LA, Davidson RJ, Stowers JM. Alterations in erythrocytes in hyperosmolar diabetic decompensation: a pathophysiological basis for impaired blood flow and for an improved design of fluid therapy. Diabetologia 1985;28:739–42.10.1007/BF00265021Suche in Google Scholar
14. Duck SC, Wyatt DT. Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr 1988;113:10–14.10.1016/S0022-3476(88)80521-3Suche in Google Scholar
15. Harris GD, Fiordalisi I, Harris WL, Mosovich LL, Finberg L. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study. J Pediatr 1990;117:22–31.10.1016/S0022-3476(05)82439-4Suche in Google Scholar
16. Harris G, Fiordalisi I, Finberg L. Safe management of diabetic ketoacidemia. J Pediatr 1988;113:65–7.10.1016/S0022-3476(88)80529-8Suche in Google Scholar
17. Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med 2001;344:264–9.10.1056/NEJM200101253440404Suche in Google Scholar PubMed
18. Glaser N. Cerebral injury and cerebral edema in children with diabetic ketoacidosis: could cerebral ischemia and reperfusion injury be involved? Pediatr Diabetes 2009;10:534–41.10.1111/j.1399-5448.2009.00511.xSuche in Google Scholar PubMed
19. Glaser NS, Wootton-Gorges SL, Buonocore MH, Tancredi DJ, Marcin JP, et al. Subclinical cerebral edema in children with diabetic ketoacidosis randomized to 2 different rehydration protocols. Pediatrics 2013;131:73–80.10.1542/peds.2012-1049Suche in Google Scholar PubMed PubMed Central
20. Glaser NS, Wootton-Gorges SL, Marcin JP, Buonocore MH, Dicarlo J, et al. Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 2004;2:164–71.10.1016/j.jpeds.2004.03.045Suche in Google Scholar PubMed
21. Yuen N, Anderson S, Glaser N, O’Donnell M. Cerebral blood flow and cerebral edema in rats with diabetic ketoacidosis. Diabetes 2008;57:2588–94.10.2337/db07-1410Suche in Google Scholar PubMed PubMed Central
22. Lawrence S, Cummings E, Gaboury I, Daneman D. Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr 2005;146:688–92.10.1016/j.jpeds.2004.12.041Suche in Google Scholar PubMed
23. Glaser N, Marcin J, Wootton-Gorges SL, Buonocore MH, Rewers A, et al. Correlation of clinical and biochemical findings with DKA-related cerebral edema in children using magnetic resonance diffusion weighted imaging. J Pediatr 2008;153:541–6.10.1016/j.jpeds.2008.04.048Suche in Google Scholar PubMed
24. Glaser NS, Ghetti S, Casper TC, Dean JM, Kuppermann N, et al. Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial. Pediatr Diabetes 2013;12:513–7.10.1111/pedi.12027Suche in Google Scholar PubMed PubMed Central
25. Kanter RK, Oliphant M, Zimmerman JJ, Stuart MJ. Arterial thrombosis causing cerebral edema in association with diabetic ketoacidosis. Crit Care Med 1987;15:175–6.10.1097/00003246-198702000-00022Suche in Google Scholar PubMed
26. Cebeci AN, Guven A, Kirmizibekmez H, Yildiz M, Dursun F. Clinical features and management of diabetic ketoacidosis in different age groups of children: children less than 5 years of age are at higher risk of metabolic decompensation. J Pediatr Endocrinol Metab 2012;25:917–25.10.1515/jpem-2012-0110Suche in Google Scholar PubMed
27. Tiwari LK, Jayashree M, Singhi S. Risk factors for cerebral edema in diabetic ketoacidosis in a developing country: role of fluid refractory shock. Pediatr Crit Care Med 2012;13:91–6.10.1097/PCC.0b013e3182196c6dSuche in Google Scholar PubMed
28. Lawrence S, Pacaud D, Dean H, Lawson M, Daneman D. Pediatric diabetic ketoacidosis. Can Med Assoc J 2003;169:278–9.Suche in Google Scholar
29. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004;113:133–40.10.1542/peds.113.2.e133Suche in Google Scholar PubMed
30. Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis-a systematic review. Ann Intensive Care 2011;1:23.10.1186/2110-5820-1-23Suche in Google Scholar PubMed PubMed Central
31. Edge JA, Jakes RW, Roy Y, Hawkins M, Winter D, et al. The UK case-control study of cerebral oedema complicating diabetic ketoacidosis in children. Diabetologia 2006;49:2002–9.10.1007/s00125-006-0363-8Suche in Google Scholar PubMed
32. Shastry RM, Bhatia V. Cerebral edema in diabetic ketoacidosis. Indian Pediatr 2006;43:701–8.Suche in Google Scholar
33. Roberts MD, Slover RH, Chase HP. Diabetic ketoacidosis with intracerebral complications. Pediatr Diabetes 2001;2:109–14.10.1034/j.1399-5448.2001.002003109.xSuche in Google Scholar PubMed
©2014 by De Gruyter
Artikel in diesem Heft
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?
Artikel in diesem Heft
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?