Preventing Cerebral Edema In Dka

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In this video, Dr. Michael Agus discusses the risk factors, signs, symptoms, and treatment of cerebral edema in diabetic ketoacidosis. Please visit: www.openpediatrics.org OPENPediatrics is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: [email protected] Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Cerebral Edema And Diabetic Ketoacidosis

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. Fortunately, it is relatively rare, but the rarity can lead to some confusion when it comes to its management. We recently discussed the use of mannitol and hypertonic saline for pediatric traumatic brain injury , but when should we consider these medications for the patient presenting with DKA? Overall tends to occur in the newly diagnosed diabetic patient (4.3% vs 1.2%). While rare, it is a devastating complication. 1990 study showed case fatality rate was 64%. Those treated BEFORE respiratory failure had lower rate of mortality (30%). The exact mechanism is not known and may be varied between individual patients. 66% within the first 7 hours of treatment (these tend to be younger). ~40% of initial brain imaging of kids with cerebral edema are NORMAL! Risk Factors for Developing Cerebral Edema This is the area that often leads to finger pointing most often those fingers being pointed toward the Emergency Physician who was initially caring for the kid. Much of the literature focused on interventions, but: Sodium Bicarb was shown to be associated with Cerebral Edema in one study Unfortunate Continue reading >>

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  1. Fallen612

    after 2 weeks of keto. my results!! and a few questions.

    well tommorow is my official 2 week weigh in but thursday night i cheated and looked. my starting weight was 175 im 5'10'' and about 20% body fat. well thurdsay night i looked and the scale said 166!! wahoo. i figure 9lbs in 2 weeks isnt bad. but theres always some questions. i went out friday night after work and didnt eat anything. my friends and i went for fast food but i didnt eat anything. until i came home and i ate some bacon. but it was late and i didnt do my workout. i felt so bad. i usually do my workout mon-fri. and take off saturday nad sunday.
    but heres my questions. today was my first carb up. i started at 9 this morning and just finished about 20 minutes ago. 12 hours. i ate
    2 kellog strawberry waffles with penut butter and syurp
    2 yogurts
    a plate of lobster ravioli
    a good bit of bread to eat with the ravioli but no crust(gross)
    a starbucks frappachino
    a cliff energy bar
    that was my carb up day. was that ok.?? hoping so i tried to keep the fat low. now my big question is will my weigh in tommorow morning be affected by this. i feel so big im gonna pop. haha. i checked the scale when i got home from eating the itallian and with my pajama pants on, t-shirt, boxers, and socks i weighed 171. but your always heaver in the evening. but i wanted to know if my weigh in will be messed up.
    and also will i need to wait and carb up in another 2 weeks?? thanks?
    and is the 6 star whey protein good stuff? i wanted to take it after my workouts? thanks!!

  2. Doobie2270

    I always weight 5-10 pounds more than normal after carbing up. There's probably no way to weight yourself tomorrow without seeing inflated results. Should be back to normal weight by wednesday.
    The only way I'm going to criticize your carb up is if you provide macro %'s.
    You only wait 1 week to carb up after initial 14-day induction. If weight loss stalls, may want to reduce carb ups to 2/month.

  3. Fallen612

    sorry for the newb question but what is macro %'s

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Management Of Diabetic Ketoacidosis

Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called non–insulin-dependent diabetes mellitus), particularly obese black patients, is not as rare as was once thought. The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients. Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults. Continuous follow-up of patients using treatment algorithms and flow sheets can help to min Continue reading >>

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  1. Robynberrill

    Okay so in May this year I was rushed into hospital after I collapsed in front of my mum. Turns out it was DKA. I admit I had been naughty with what I was eating and not taking the correct doses of insulin. I was in hospital for just over a week and the doctors saw a dramatic decrease in my blood sugar levels.
    Since then I have been very careful with what I eat and making sure I am taking the correct doses of my insulin.
    But I feel like I'm going downhill again. I am still very careful with what I am eating. I dread injecting insulin every day because it still seems to hurt and leave nasty lumps and bruises even though I should be used to it all by now (been diagnosed a year)
    I'm really finding it hard and I just want some advise or if anyone has/is feeling the same.

  2. Juicyj

    Robynberrill said: ↑
    Okay so in May this year I was rushed into hospital after I collapsed in front of my mum. Turns out it was DKA. I admit I had been naughty with what I was eating and not taking the correct doses of insulin. I was in hospital for just over a week and the doctors saw a dramatic decrease in my blood sugar levels.
    Since then I have been very careful with what I eat and making sure I am taking the correct doses of my insulin.
    But I feel like I'm going downhill again. I am still very careful with what I am eating. I dread injecting insulin every day because it still seems to hurt and leave nasty lumps and bruises even though I should be used to it all by now (been diagnosed a year)
    I'm really finding it hard and I just want some advise or if anyone has/is feeling the same.
    Click to expand... Hiya I have just read this post after responding to your other thread.
    Glad you are well now and understand the dangers of not taking the right amount of insulin. Taking insulin is essential for your energy levels, if you don't take enough then you run high and your body slows down with too much glucose on board, so hence why your energy levels are poor. I mentioned in my other response about routine and it's pants I know but you need to get into a routine of testing and injecting, looking after yourself and getting good health is a priority.
    If injecting is becoming a problem then speak to your DSN and tell them this, as you will need to do this for the rest of your life, well until they find a cure that is..

  3. novorapidboi26

    its quite common to lose momentum from time to time throughout your diabetic life the trick is to be able to get back into the swing of things........
    for me this is made easier by having the knowledge and experience of dose adjustment/carb counting.......
    have you had any formal training on this?

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Pediatric diabetic ketoacidosis practice essentials, background cerebral edema in children with. However cerebral edema is the most frequent serious complication of diabetic ketoacidosis (dka) in children, occurring 1. 10,29 it is manifested by 25 apr 2014 diabetic ketoacidosis, together with the major complication of most cases of cerebral edema occur 4 12 hours after initiation of treatment the diagnosis and treatment of diabetic ketoacidosis in children is discussed incidence clinically significant cerebral edema occurs in approximately 1 but do not independently support the efficacy of physiologic management what's known on this subject cerebral edema (ce) occurs frequently during treatment fluid infusion in children with dka does not substantially affect current research on the assessment of the risk of cerebral edema in patients with diabetic and ketoacidosis and an appropriate diagnosis and therapy do not allow for the nerable to injury when hypocapnia occurs in children with dka. Probably occurs in most cases during or even before treatment. Cerebral edema is the leading cause of death in children presenting diabetic ketoacidosis and occurs 0. Diabetic emergencies diabetic ketoacidosis in adults, part 4. The causes of dka related cerebral edema are not well understood. Which edema did not occur with reduc complications do in dka, most commonly hypoglycemia, hypophosphatemia, hypokalemia, etc. Ncbi diabetic ketoacidosis and cerebral edema. Cerebral edema and diabetic ketoacidosis pediatric em morsels. Onset of treatment, and it was claimed that they did not have brain oedema [12] objective children who develop cerebral edema (ce) during diabetic ketoacidosis. Objective to review the causes of cerebral edema in diabetic dosis as it pertains prevention. Diabetic ketoacidosis and cerebral edema. Cerebral edema in diabetic ketoacidosis a look beyond cerebral children with uptodate. Cerebral edema in diabetic ketoacidosis emergpaadult cerebral after treatment of children with complicating. Gov pubmed 12011666 cerebral edema is the leading cause of death in children presenting diabetic ketoacidosis and occurs 0. Krane dka and cerebral edema pedsccm. The journal of family practice. Diabetic ketoacidosis and cerebral edemadiabetic edema. Subclinical cerebral edema in children with diabetic ketoacidosis risk of the. Symptomatic cerebral oedema during treatment of diabetic edema in childhood ketoacidosis diabetes care. Cerebral edema after that a limited increase in brain water did occur with its use. Overall tends to occur in the newly diagnosed diabetic patient (4. Cerebral edema is a rare, but severe complication in role the pathogenesis of cerebral after treatment dka. Mechanism of cerebral edema in children with diabetic ketoacidosis. Risk factors for cerebral edema during dka There is increased ensure that the corrected na does not decrease over first 12 hours, then no faster than 1 19 aug 2010 oedema most feared complication of. Initially,

What Are The Diagnostic Criteria For Cerebral Edema In Diabetic Ketoacidosis (dka)?

What are the diagnostic criteria for cerebral edema in diabetic ketoacidosis (DKA)? Muir et al have identified diagnostic criteria for cerebral edema that include abnormal response to pain, decorticate and decerebrate posturing, cranial nerve palsies, abnormal central nervous system respiratory patterns, fluctuating level of consciousness, sustained heart rate deceleration, incontinence, and more nonspecific criteria such as vomiting, headache, lethargy, and elevated diastolic blood pressure. [ 27 ] Cerebral edema begins with mental status changes and is believed to be due partially to idiogenic osmoles, which have stabilized brain cells from shrinking while the diabetic ketoacidosis was developing. Glaser NS, Marcin JP, Wootton-Gorges SL, et al. Correlation of clinical and biochemical findings with diabetic ketoacidosis-related cerebral edema in children using magnetic resonance diffusion-weighted imaging. J Pediatr. 2008 Jun 25. [Medline] . Umpierrez GE, Jones S, Smiley D, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009 Jul. 32(7):1164-9. [Medline] . [Full Text] . Herrington W Continue reading >>

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  1. mtnbknggrl

    My trainer recently put my on a 1300 calorie meal plan. She has broken it up to 5 meals per day at 260 p/m. She wants me to break it down to a 45/25/20 ratio p/m but i am struggling with making that work. Everything that i find that is healthy for me to eat, i cannot fit it together. Any ideas or suggestions on what to do? It is very frustrating, i have been working on it for a few days and cannot seem to make it fit.
    Thanks for your help.

  2. ianianian

    1. get rid of that trainer
    2. start at 2200 calories (if weight loss stalls, drop 100-150 calories, rinse repeat)
    3. sit and read these forums

  3. PBateman2

    Before you get rid of the trainer, can you ask him/her why 1300 calories to start? Im curious to know.

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