Medicina
Páginas: 2 (309 palabras)
Publicado: 9 de octubre de 2012
The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne
RISK FACTORS FOR CEREBRAL EDEMA IN CHILDREN WITH DIABETIC KETOACIDOSIS
NICOLE GLASER, M.D., PETER BARNETT, M.B., B.S., IAN MCCASLIN,M.D., DAVID NELSON, M.D., JENNIFER TRAINOR, M.D., JEFFREY LOUIE, M.D., FRANCINE KAUFMAN, M.D., KIMBERLY QUAYLE, M.D., MARK ROBACK, M.D., RICHARD MALLEY, M.D., AND NATHAN KUPPERMANN, M.D.,M.P.H., FOR THE PEDIATRIC EMERGENCY MEDICINE COLLABORATIVE RESEARCH COMMITTEE OF THE AMERICAN ACADEMY OF PEDIATRICS
ABSTRACT
Background Cerebral edema is an uncommon but
devastatingcomplication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined. Methods In this multicenter study, we identified 61 children who had beenhospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema werealso identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes (established vs. newlydiagnosed disease), initial serum glucose concentration, and initial venous pH. Using logistic regression, we compared the three groups with respect to demographic characteristics and biochemicalvariables at presentation and compared the matched groups with respect to therapeutic interventions and changes in biochemical values during treatment. Results A comparison of the childrenin the cerebral-edema group with those in the random control group showed that cerebral edema was significantly associated with lower initial partial pressures of arterial carbon dioxide(relative risk of cerebral edema for each decrease of 7.8 mm Hg [representing 1 SD], 3.4; 95 percent confidence interval, 1.9 to 6.3; P300 mg per deciliter [16.7 mmol per liter], a venous pH
RISK FACTORS FOR CEREBRAL EDEMA IN CHILDREN WITH DIABETIC KETOACIDOSIS
NICOLE GLASER, M.D., PETER BARNETT, M.B., B.S., IAN MCCASLIN,M.D., DAVID NELSON, M.D., JENNIFER TRAINOR, M.D., JEFFREY LOUIE, M.D., FRANCINE KAUFMAN, M.D., KIMBERLY QUAYLE, M.D., MARK ROBACK, M.D., RICHARD MALLEY, M.D., AND NATHAN KUPPERMANN, M.D.,M.P.H., FOR THE PEDIATRIC EMERGENCY MEDICINE COLLABORATIVE RESEARCH COMMITTEE OF THE AMERICAN ACADEMY OF PEDIATRICS
ABSTRACT
Background Cerebral edema is an uncommon but
devastatingcomplication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined. Methods In this multicenter study, we identified 61 children who had beenhospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema werealso identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes (established vs. newlydiagnosed disease), initial serum glucose concentration, and initial venous pH. Using logistic regression, we compared the three groups with respect to demographic characteristics and biochemicalvariables at presentation and compared the matched groups with respect to therapeutic interventions and changes in biochemical values during treatment. Results A comparison of the childrenin the cerebral-edema group with those in the random control group showed that cerebral edema was significantly associated with lower initial partial pressures of arterial carbon dioxide(relative risk of cerebral edema for each decrease of 7.8 mm Hg [representing 1 SD], 3.4; 95 percent confidence interval, 1.9 to 6.3; P300 mg per deciliter [16.7 mmol per liter], a venous pH
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