Why does DKA cause cerebral Oedema?

Why does DKA cause cerebral Oedema?

Cerebral edema is the leading cause of death in children presenting in diabetic ketoacidosis and occurs in 0.2 to 1% of cases. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume.

Can DKA cause hypernatremia?

Diabetic ketoacidosis (DKA) causes a hyperosmolar state driven by the osmotic force of hyperglycemia in the intravascular space. Dilutional hyponatremia is common due to water driven into the intravascular space from inside cells. On rare occasions, hypernatremia is found in DKA.

How does DKA affect sodium levels?

Because of the osmotic shift of water, plasma sodium concentrations are usually low or normal in DKA and can be slightly increased in HHS, despite extensive water loss.

Why does hyperglycemia cause cerebral edema?

Cerebral edema occurs when fluid moves from the extracellular to intracellular space faster than brain cells can adapt to increased intracellular volume. This can happen when hypernatremia or hyperglycemia is corrected too rapidly, leading to a sudden and pronounced drop in serum osmolality.

What is cerebral Oedema?

The most basic definition of cerebral edema is swelling of the brain. It is a relatively common phenomenon with numerous etiologies. Cerebral edema categorizes into either vasogenic, cellular, osmotic, and interstitial causes.

How does DKA prevent cerebral edema?

Therapeutic guidelines to prevent cerebral edema in diabetic ketoacidosis include slow rehydration over about 48 hours, avoidance of hypotonicity and of unnecessary alkali therapy. Early recognition of cerebral edema and prompt institution of hypertonic therapy with mannitol may prevent permanent neurological sequelae.

Why does HHS cause hypernatremia?

In patients with HHS, hypernatremia is causally associated with a water deficit secondary to an osmotic diuresis-induced hypotonic loss, which results in a loss of water exceeding that of sodium.

Is DKA hypokalemia or hyperkalemia?

DKA is a well-known cause of hypokalemia caused by osmotic diuresis leading to a total body potassium deficiency of 3 to 6 mEq/kg. At presentation, potassium levels are typically “normal” due to the extracellular shift of potassium (K+) from insulin deficiency and acidosis.

When does Hypernatremia occur?

Hypernatremia occurs when the serum sodium concentration is higher than 145 milliequivalents per liter (mEq/l) . It means that the level of sodium in a person’s blood is too high. Two common causes of hypernatremia are insufficient fluid intake and too much water loss.

What is the treatment for cerebral edema?

Symptoms appear as the intracranial pressure (ICP) rises above 20 cm H2O in most patients. Treatment for cerebral edema targets the underlying cause and any life-threatening complications. Treatments include hyperventilation, osmotherapy, diuretics, corticosteroids, and surgical decompression.

What happens when the brain swells?

Wherever it occurs, brain swelling increases pressure inside the skull. That’s known as intracranial pressure, or ICP. This pressure can prevent blood from flowing to your brain, which deprives it of the oxygen it needs to function.