Diabetische ketoacidose: nog steeds een levensbedreigende ziekte

Abstract

Diabetic ketoacidosis: still a life-threatening disease. This report details a rare occurrence of cerebral edema as a complication of diabetic ketoacidosis (DKA) in an 18-year old male. The patient presented with headache, and on further inquiry typical symptoms of DKA (polyuria, polydipsia and weight loss). During treatment his condition rapidly deteriorated resulting in neurological collapse and coma. A CT-scan revealed signs of cerebral edema. Although the exact pathophysiology is not fully understood, it is believed that both DKA-related (cytotoxic and vasogenic) and treatment-related factors play a role. Cerebral edema caused by DKA can be fatal, or result in persisting neurologic deficits. Proper use of intravenous (IV) resuscitation fluids and avoidance of IV bicarbonate and IV insulin bolus is necessary to avoid exacerbation of pre-existing cerebral edema, as described in this case report. Neurological monitoring, before and during treatment, is essential, as early detection and treatment of cerebral edema improves outcome. If clinical signs of cerebral edema, mannitol 20% or hypertonic salt IV should be administered immediately. This case emphasizes the importance of careful metabolic and neurological monitoring and adherence to appropriate treatment principles in DKA to reduce the risk of cerebral edema. Increasing awareness of this complication among healthcare providers can help intervene in a timely manner and improve outcome for the patient.