Diabetes
Cerebral edema nothing to do with fluid amount (Arch Dis Child 85:16, 2001, N Engl J Med 344(4):264, January 25, 2001)
Best review article on DKA and cerebral edema is in EMJ (Emerg Med J 2004; 21:141-144)
Get serum Osm
Insulin=pH
Hydration=Glucose
At least 10% dehydrated so 100cc/kg
Cerebral Edema-HA, AMS, Vomitting, Rx c Mannitol and Hyperventilation
NS for 2-4 hours then ½ NS c 20 meq KCl and 20 of KPhos to each bag
Capnometry can be used for noninvasive continuous monitoring (Crit Care Med 2003 31:10)
The theory suggests that overzealous insulin use or hydration with excess free water administration to children with DKA cause a dramatic dysequilibrium between the osmolality of the serum and that of the brain. A fluid shift along this osmolar gradient is then responsible for CO. According to this theory, there are osmotically active substances in brain cells that prevent dehydration during acute hyperglycaemia. When the serum glucose is rapidly lowered these substances remain in the brain cells, and an intracellular osmotic gradient is created that results in CO. Proponents of this theory also feel that excess secretion of antidiuretic hormone may occur and that rapidly falling serum osmolality and serum sodium concentrations that decline or remain constant during treatment are an ominous sign for potentially impending CO
Back to topHypoglycemia
Check ETOH and Salicylate Levels: both can cause hypoglycemia in kiddies.
Give 0.5 to 1 gm/kg of Dextrose Neonates D10, Infants D25,
| | |
Back to top