[Fluid management and the risk of cerebral oedema in children with diabetic ketoacidosis].

BACKGROUND

Cerebral oedema is a rare but life-threatening complication of diabetic ketoacidosis in children.

MATERIAL AND

METHODS

This paper presents a case report on an infant with diabetic ketoacidosis and in an extreme hyperosmolar and hypernatremic state. Considerations regarding appropriate fluid management and the osmotic role of serum sodium are discussed. Recommendations for treatment are given based on available guidelines and published evidence.

INTERPRETATION: Intracellular swelling of the brain seems to be caused by water moving along osmotic gradients. In diabetic ketoacidosis, sodium and glucose are the dominant osmotic forces. It is important to understand the relation between serum osmolarity, sodium and glucose, as appropriate fluid treatment might prevent this potentially fatal complication.