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Dka Hypernatremia

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Diabetic Ketoacidosis And Cerebral Edema

Elliot J. Krane, M.D. Departments of Pediatrics and Anesthesiology Stanford University Medical Center Introduction In 1922 Banting and Best introduced insulin into clinical practice. A decade later the first reported case of cerebral edema complicating diabetic ketoacidosis (DKA) was reported by Dillon, Riggs and Dyer writing in the pathology literature. While the syndrome of cerebral edema complicating DKA was either not seen, ignored, or was unrecognized by the medical community until 3 decades later when the complication was again reported by Young and Bradley at the Joslin Clinic, there has since been a flurry of case reports in the 1960's and 1970's and basic and clinical research from the 1970's to the 1990's leading to our present day acceptance of this as a known complication of DKA, or of the management of DKA. In fact, we now recognize that the cerebral complications of DKA (including much less frequent cerebral arterial infarctions, venous sinus thrombosis, and central nervous system infections) are the most common cause of diabetic-related death of young diabetic patients (1), accounting for 31% of deaths associated with DKA and 20% of all diabetic deaths, having surpas Continue reading >>

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Popular Questions

  1. launchpad

    can anyone plz tell me what happens to the Na and K levels in DKA.kaplan says there is hypernatremia and hypokalemia.

  2. frontal

    There is no hypernatremia in DKA. There is electrolyte loss in DKA primariy due to hyperglycemia causing osmotic diuresis, so the patient is depleted of both Na and K, but the serum levels of potassium maybe normal or even elevated. This is because of a disproportionate loss of water (osmotic diuresis) and because of acidosis, which forces the hydrogen ions into cells in exchange for K ions. Remember: a patient with DKA is potassium depleted, even if serum potassium values are on the higher side at presentation. Renal loss continues and as treatment with insulin is started, a fall in serum potassium is likely to be observed because insulin pushes the K ions back into the cells. Electrolye monitoring is necessary while treating the patient, so that insulin dose can be adjusted and fluids given appropriately.

  3. frontal

    A normal serum sodium level in DKA would indicate profound dehydration.

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