How is cerebral edema treated in DKA?

Mannitol (0.25-1g/kg) is the most frequently used treatment for DKA-related cerebral edema. Mannitol should be given as soon as a clinical diagnosis of DKA-related cerebral edema is made.

Do you give mannitol for cerebral edema?

We suggest using either hypertonic sodium solutions or mannitol for the initial management of ICP or cerebral edema in patients with acute ischemic stroke (conditional recommendation, low-quality evidence).

When do you give a mannitol for a head injury?

Background. Mannitol is sometimes effective in reversing acute brain swelling, but its effectiveness in the ongoing management of severe head injury remains unclear. There is evidence that, in prolonged dosage, mannitol may pass from the blood into the brain, where it might cause increased intracranial pressure.

Is cerebral edema common in DKA?

Cerebral injury (cerebral edema) is an uncommon but potentially devastating consequence of diabetic ketoacidosis (DKA). This complication is far more common among children with DKA than among adults.

Can DKA cause brain swelling?

Abstract. Commonly seen in the emergency department, diabetic ketoacidosis is a potentially lethal sequela of uncontrolled diabetes mellitus. In the adult population, a rare complication of diabetic ketoacidosis is cerebral edema.

Why is mannitol given for ICP?

Mannitol exerts its ICP-lowering effects via two mechanisms—an immediate effect because of plasma expansion and a slightly delayed effect related to its osmotic action. The early plasma expansion reduces blood viscosity and this in turn improves regional cerebral microvascular flow and oxygenation.

Is mannitol contraindicated in SDH?

If SDH is causing brain herniation, as evidenced by oculomotor palsy or Cushing’s reflex (bradycardia, hypertension, and irregular respirations), hyperosmolar therapy with mannitol (an osmotic diuretic) should be considered. Mannitol general dosing is 0.25 to 1 gm/kg i.v. bolus given as quickly as possible.

How does DKA cause cerebral edema?

Abstract. Cerebral edema is the leading cause of death in children presenting in diabetic ketoacidosis and occurs in 0.2 to 1% of cases. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume.

How does hypertonic saline help cerebral edema?

Hyperosmolar therapies, specifically referencing mannitol and hypertonic saline (HTS), create an osmolar gradient, which allows cerebrospinal fluid to move from the cranial space, leading to a decrease in ICP.

What causes cerebral edema in pediatric DKA?

Cerebral edema (swelling of the brain) is the most frequent serious complication of diabetic ketoacidosis (DKA) in children. The cause of cerebral edema during DKA is not well understood. Recent studies suggest that it may result from lack of adequate blood flow to the brain during DKA, before treatment starts.