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[IP] low blood sugar treatment can kill

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Low-blood sugar diabetes treatment can kill-study
Release at 5 P.M. (2200 GMT) 

By Gene Emery 

BOSTON, Jan 24 (Reuters) - A common treatment for diabetic children whose 
blood sugar has fallen too low can cause fatal brain swelling, researchers 
from the University of California at Davis School of Medicine warned in 
Thursday's New England Journal of Medicine. 

The treatment involves giving the children a sodium bicarbonate injection to 
youngsters whose blood sugar level is too low, a condition known as diabetic 

In a study of 6,977 medical records spanning 15 years, the UC Davis team led 
by Dr. Nicole Glaser found that the bicarbonate therapy increases the 
likelihood that the brain will begin to swell. 

Although such swelling occurs in only 1 percent of the children suffering 
from diabetic ketoacidosis, it is fatal in as many as 9 out of 10 youngsters 
who develop it. Those who survive often suffer permanent brain damage. 

Such brain swelling, called cerebral edema, is responsible for up to 60 
percent of diabetes-related deaths in children. 

Dr. Nathan Kuppermann, an author of the research, said this is the first 
study to confirm the suspicion that treatment with bicarbonate -- essentially 
baking soda -- can be extremely dangerous. 

"I imagine doctors in emergency departments and pediatric intensive care 
units will put this knowledge into effect immediately," said Kuppermann, in a 
statement released by UC Davis. 

Doctors give bicarbonate in hopes of neutralizing the acids in the blood that 
rise to toxic levels when blood sugar levels drop too far, producing the 
fatigue, thirst, nausea, labored breathing and confusion that are hallmarks 
of ketoacidosis. The problem requires emergency medical treatment. 

About 25 to 40 percent of children with diabetes don't realize they have the 
disease until they develop ketoacidosis. 

Glaser, in an interview with Reuters, warned against using the treatment on 

"There are some specific situations where you might want to use bicarbonate 
because it might be life-saving. It's just that in the standard child with 
diabetic ketoacidosis, it shouldn't be used," she said. 

The researchers said they also discovered that children whose blood shows low 
levels of carbon dioxide and high levels of urea nitrogen face the highest 
risk for brain swelling. 

Glaser said she hopes doctors can use that information "to better monitor the 
high-risk children, and pick up the initial signs of (cerebral edema) before 
it progresses to a more serious stage." 

In such cases, drugs to reduce the swelling can be given. 

But it was not clear whether the findings applied to adults because "adults 
don't seem to get cerebral edema," Glaser said. 

10:08 01-24-01
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