Endocrine Abstracts

Prevention, diagnosing, and adequate management of cerebral oedema in diabetic ketoacidosis are of vital importance. This can be very challenging in infants and toddlers as symptoms can be very subtle or difficult to interpret. Young age, new diagnosis of diabetes, and severe acidosis at presentation has been reported as risk factors for the development of cerebral oedema. We report our experience in managing one infant and two toddlers newly diagnosed diabetics who were referred to our paediatric intensive care unit with cerebral oedema in a 6 months period.

Their ages ranged from 8 to 17 months. They all presented to their local hospitals with short histories of vomiting, tachypnoea, and being generally unwell. Their blood sugars readings on admission ranged from 22 to 77 mmol/l, with severe acidosis, high blood ketones, high plasma sodium, high urea and they received 20–40 ml/kg of fluid boluses. They were referred to our unit following diagnosis and initial management of probable cerebral oedema. They were managed using various guidelines all based on the ISPAD consensus 2009.

Mannitol is known to cause a huge diuresis following its administration and hypertonic saline 3% raises plasma sodium by 0.8–1 mmol/l both posing a challenge in the presence of high plasma osmolality, fluid restriction and plasma sodium of more than 160 mmol/l. Managing these un-intubated children in the PICU was challenging, as they were irritable and fit into the major and minor criteria for the bedside evaluation of the neurological state and difficulties in placing monitoring lines without sedation.