Diabetic Ketoacidosis-Associated Stroke in Children and Youth

Diabetic ketoacidosis (DKA) is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia and ketonemia. Although possibly underappreciated, up to 10% of cases of intracerebral complications associated with an episode of DKA, and/or its treatment, in children and youth are due to hemorrhage or ischemic brain infarction. Systemic inflammation is present in DKA, with resultant vascular endothelial perturbation that may result in coagulopathy and increased hemorrhagic risk. Thrombotic risk during DKA is elevated by abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. DKA-associated cerebral edema may also predispose to ischemic injury and hemorrhage, though cases of stroke without concomitant cerebral edema have been identified. We review the current literature regarding the pathogenesis of stroke during an episode of DKA in children and youth.

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Cerebrovascular Accident Complicating Diabetic Ketoacidosis in a Nigerian Adolescent: A Case Report and Review of the Literature

Annals of Health Research ◽

10.30442/ahr.0704-09-151 ◽

2021 ◽

Vol 7 (4) ◽

pp. 410-414

Author(s):

IJ Akinola ◽

G Akinyosoye ◽

SA Adedokun

Keyword(s):

Case Report ◽

Diabetic Ketoacidosis ◽

Cerebrovascular Accident ◽

Vascular Reactivity ◽

Cerebral Oedema ◽

Neurological Complication ◽

Coagulation Factors ◽

Paediatric Population ◽

Review Of The Literature ◽

Cerebrovascular Accidents

Cerebrovascular accident (CVA) is a rare neurological complication of diabetic ketoacidosis (DKA) in the paediatric population. The risk of developing CVA in DKA patients is often increased due to abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. Cerebral oedema, the most common neurological complication of DKA, may also predispose to CVA. We report the case of a -12-year-old adolescent with DKA complicated by CVA. She developed features of right hemispheric CVA while on admission and had radiological confirmation of an ischaemic CVA. This report highlights that cerebrovascular accidents in DKA can easily be missed or confused with cerebral oedema.

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FATAL CEREBRAL (EDEMA WITH INSULITIS IN DIABETIC KETOACIDOSIS

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1973.tb129825.x ◽

1973 ◽

Vol 2 (20) ◽

pp. 934-937 ◽

Cited By ~ 11

Author(s):

G. L. Warne

Keyword(s):

Diabetic Ketoacidosis ◽

Cerebral Edema

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Cerebrovascular complications of diabetic ketoacidosis in children

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302011000400009 ◽

2011 ◽

Vol 55 (4) ◽

pp. 288-290 ◽

Cited By ~ 7

Author(s):

Luis Felipe Mendonça de Siqueira

Keyword(s):

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Neurological Complications ◽

Neurological Deterioration ◽

Cerebrovascular Complications

Neurological deterioration in children with diabetic ketoacidosis (DKA) is commonly caused by cerebral edema. However, subtle cerebral injuries including strokes should also be suspected, since children with hyperglycemia and DKA are prone to thrombosis. In this paper, a case involving a 2 month-old patient that presented cerebral edema and stroke as complications of DKA is reported. In the discussion, the literature on neurological complications of DKA in children is briefly reviewed, emphasizing the prothrombotic tendency of these patients.

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Pediatric Diabetic Ketoacidosis and Hypoglycemia

10.2310/em.4413 ◽

2020 ◽

Author(s):

Rachel J Williams ◽

Samantha L. Wood

Keyword(s):

Emergency Department ◽

Key Words ◽

Diabetic Ketoacidosis ◽

Critically Ill ◽

Cerebral Edema ◽

Critically Ill Patients ◽

Pediatric Patients ◽

Serum Glucose ◽

Neurologic Function ◽

Threat To Life

Abnormalities of serum glucose in pediatric patients are commonly encountered in the emergency department and represent an acute threat to life and neurologic function. Rapidly identifying and aggressively treating hyperglycemia with diabetic ketoacidosis and hypoglycemia are critical to ensure the best possible outcome. This review will guide the emergency provider in the identification, resuscitation, workup, and disposition of these critically ill patients. This review contains 6 figures, 13 tables, and 50 reviews. Key Words: Cerebral edema, diabetic ketoacidosis, hyperglycemia, hypoglycemia

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A RARE CASE MORTALITY OF DIABETIC KETOACIDOSIS- CEREBRAL EDEMA WITH TONSILLAR HERNIATION- A CONTRADICTORY OPINION.IS SODIUM BICARBONATE A REAL CULPRIT?

10.36106/1503265 ◽

2021 ◽

pp. 8-10

Author(s):

Sruthi P ◽

Manzoor Sharieff M ◽

Prasanth Kumar P ◽

Vishnu priya V ◽

Nagarajan N ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Hydrogen Exchange ◽

Ketone Bodies ◽

Acetoacetic Acid ◽

Tonsillar Herniation ◽

Sodium Hydrogen ◽

Uncontrolled Diabetes ◽

Case Mortality

Diabetic ketoacidosis (DKA) is the most common complication seen in uncontrolled diabetes mellitus. DKA is most commonly seen with patients of type 1 diabetes. Depletion of Insulin leads to high blood sugars which in turn leads osmotic diuresis, production of ketone bodies i.e, βhydroxybutyric acid and acetoacetic acid, dysregulation of sodium hydrogen exchange mechanism[2]. As a consequence to the above stated mechanisms, cerebral edema has been documented as a fatal complication in DKA. Mortality documented due to cerebral edema is 21-25%[4].

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Inflammation and thrombosis in diabetes

Thrombosis and Haemostasis ◽

10.1160/ths10-11-0739 ◽

2011 ◽

Vol 105 (S 06) ◽

pp. S43-S54 ◽

Cited By ~ 70

Author(s):

Katharina Hess ◽

Peter Grant

Keyword(s):

Plaque Rupture ◽

Thrombus Formation ◽

Atherosclerotic Lesion ◽

Coagulation Factors ◽

Fibrin Clot ◽

Thrombotic Risk ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Patients With Diabetes ◽

Inflammatory State

SummaryPatients with diabetes mellitus are at increased risk of cardiovascular morbidity and mortality. Atherothrombosis, defined as atherosclerotic lesion disruption with superimposed thrombus formation, is the most common cause of death among these patients. Following plaque rupture, adherence of platelets is followed by local activation of coagulation, the formation of a cross-linked fibrin clot and the development of an occlusive platelet rich fibrin mesh. Patients with diabetes exhibit a thrombotic risk clustering which is composed of hyper-reactive platelets, up regulation of pro-thrombotic markers and suppression of fibrinolysis. These changes are mainly mediated by the presence of insulin resistance and dysglycaemia and an increased inflammatory state which directly affects platelet function, coagulation factors and clot structure. This prothrombotic state is related to increased cardiovascular risk and may account for the reduced response to antithrombotic therapeutic approaches, underpinning the need for adequate antithrombotic therapy in patients with diabetes to reduce their cardiovascular mortality.

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