Cerebral oedema and death following diabetic ketoacidosis

Lead investigator

Dr J Edge

About the study

Cerebral oedema was a devastating complication of diabetic ketoacidosis (OKA) in children, and appeared to be sporadic and unpredictable. The most recent figures available during the surveillance start date showed between ten and twenty children under 19 years of age die per year from OKA in Britain. Of OKA deaths over a period of 25 years in a large American study, 50% could be attributed to cerebral oedema; other causes of death in association with OKA may have been much less common.

The incidence of cerebral oedema in Britain was not known. The aetiology of cerebral oedema during treatment for OKA was not understood, and even with optimum management standards at the time, cases still occurred. Retrospective studies suggested that cerebral oedema was more common in newly diagnosed diabetes, especially in children under 5 years of age. It was initially thought that the post-mortem changes may have resulted from cerebral anoxia from the reduced blood volume and haemoconcentration. Further contributing factors in the development of cerebral oedema may have been hypoxia resulting from rapid bicarbonate infusion, a high initial plasma glucose concentration, the rate and/or quantity of intravenous fluid administration, and a fall in plasma sodium concentration. Animal studies suggested that insulin itself was required for cerebral oedema to occur. There had been no sizeable case-control studies to support any of these theories.

This study aimed to compare the clinical course of cases of cerebral oedema with controls who had OKA but no cerebral oedema, ascertained by a separate reporting mechanism that the team developed. This study was the first large prospective case-control study in this important area of research. The study also wished to investigate outcomes of cerebral oedema in the UK.

Duration

October 1995 – September 1998

Published papers

Support Group

Diabetes UK | helpline@diabetes.org.uk