The Turkish Journal of Pediatrics 2005; 47: 170-172 Case Cerebral complications in diabetic ketoacidosis

Although much is known about diabetic ketoacidosis (DKA) and its treatment, the pathology of cerebral complications in patients who develop ketoacidosis is not yet well understood. In this article, we discuss the cerebral complications due to DKA by presenting two cases who were admitted with severe DKA and who both developed early and severe neurological complications. Key words: diabetic ketoacidosis, cerebral edema. Despite recent progress in the diagnosis and long-term treatment of type 1 diabetes, diabetic ketoacidosis (DKA) continues to be the most significant cause of death in childhood diabetes. According to the studies reported from the United States, mortality due to DKA is between 0.21 and 0.25%1. Late referrals to hospitals and/ or insufficient treatment regimens are responsible for even higher mortality rates in some countries and regions2. The mortality of DKA is mostly due to cerebral complications, of which the most is frequently seen cerebral edema. Although DKA can be seen in all ages, cerebral edema usually occurs in childhood. Glaser et al. reported 6,977 DKA case from the United States, of whom 61 (0.8%) presented with cerebral edema; 13 (21%) of those died and 13 (21%) recovered with severe neurologic deficits3. It is not clear if cerebral complications are related to the treatment or if they develop in an idiosyncratic manner. However, it is worthwhile to estimate the risk of complications and to carry out the treatment regimen according to the severity of the risk. In this report, cerebral complications due to DKA are discussed by presenting two cases of severe DKA with an emphasis on their treatments