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[IP] RE: Response to Kerri's question : non-responding highs and brain swelling (long)

Kerri stated:
>>I've heard this before from some parents on the CWD list
but from
what I've ever been able to find, this only applies to DKA.
Perhaps Spot and/or Barbara Bradley can shed more light on
When my daughter was in DKA at dx they told me that bringing
bg down too fast etc could cause swelling on the brain.<<

This condition (aka cerebral edema) can occur as a
complication of DKA treatment in children. It may also be
associated with the fluid resuscitation that is usually
required in DKA. DKA is a fluid resuscitation emergency
because of the dehydration. There is also some relationship
to sodium dilution from the IV therapy. It is also a big
reason for admission to an ICU for frequent monitoring of
level of consciousness, BG, electrolytes, intake and output,
cardiac monitoring, etc.  Symptoms may be increased lethargy
and diminished arousability, incontinence, or complaints of

The recommendation is to not let the BG fall faster than
50 - 75 mg/dl per hour to prevent fluid shifts, and to
prevent symptoms of low BG even though the BG isn't low,
just could be dropping to quickly. When the BG gets to the
250mg/dl range, insulin resistance from the high BG and
ketones will be less, and the BG could fall very quickly. At
this point you will see an IV with glucose added to prevent
the BG from falling too fast.  Insulin is still needed at
this point, since the insulin, glucose, water, and
electolytes are continuing to be moved back into the cells.
It is also thought to be related to the degree of acidisis
and its effect on the brain.

Intake of solid food may still be limited, unless bowel
sounds are present. It is believed that the abdominal pain
of DKA is related to the loss of potassium causing a slowing
of the gut.  When the potassium levels are in a safe normal
range, the bowel will begin to have more normal peristalsis
(forward movement on the inside of the bowel).  This
function is also slowed down with the high BGs.

To find more detailed explanations, you can do an internet
search for DKA and cerebral edema in children.

Barbara A. Bradley, MS, RN, CDE
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