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- W1567881147 abstract "Cerebral edema probably occurs universally with insulin and fluid treatment of severe DKA. The cause of life-threatening BH during treatment of DKA is unknown. No recommendations are proffered in recent reviews to suggest ways to prevent BH. History, laboratory data, rate of fluid administration and rapidity of onset from nine new cases of BH plus 33 cases from the literature were analyzed. Of note, calculated sodium conc. (M. Katz, NEJM [1973] 289:843) decreased between initiation of therapy and the hour of onset of BH (138.7 ± 6.2 mM vs 134.1 ± 8.3 mM, t=2.68, p=.02), and these were correlated: r=0.6l, p<0.01, n=18. Serum K+ conc. decreased during the same time period (5.0 ± 0.9 vs 3.7 ± 1.0 mM; t=5.54, p<0.001) but were not correlated. These data with the knowledge that vasopressin is inappropriately regulated in DKA, should alert the physician to be aware of the syndrome of inappropriate ADH in exacerbating BH. Unpaired t-test analysis excluded factors of sex, previous diagnosis of diabetes, NaHCO3 in the initial fluid treatment or the presence of stupor on admission as affecting laboratory values, fluid administration rates or onset of BH. Only the rate of fluid administration (7.4 ± 2.8 L/m2/day; n=40) was significantly related to rapidity of onset of BH (r=-0.32, p=.04). Only 4 of 40 cases occurred when fluid administration was <4 L/m2/day. Limitation of the rate of fluid administration to a value <4 L/m2/day continues to be a prudent recommendation in the treatment of DKA." @default.
- W1567881147 created "2016-06-24" @default.
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- W1567881147 date "1988-01-01" @default.
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- W1567881147 title "FLUID ADMINISTRATION RATE AFFECTS ONSET OF BRAINSTEM HERNIATION (BH) IN DIABETIC KETOACIDOSIS (DKA)" @default.
- W1567881147 doi "https://doi.org/10.1203/00006450-198801000-00086" @default.
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