Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are loss (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypolglycemia, and Acute Pancreatitis.
Cerebral Edema is a rare but fatal complication of diabetic ketoacidosis. To thoroughly describe the clinical signs of cerebral edema is characterized by “deterioration in the level of consciouness, with lethargy, decrease in arousal and headache. The timing of the development of cerebral edema is variable, with most cases occurring 4 to 12 hours after starting treatment. Several case reports showed presence of cerebral edema before the itntiation of therapy. A method of clinical diagnosis based on bedside evaluation of a neurological state in DKA have been developed.” (Pandey)
Primarly, cerebral edema occurs in children. Studies show that the largest reported cases are 95% with patients younger than 20 years of age. One third of these cases occur in patients younger than 5 years of age. Generally, after the initiation of therapy, within 3-12 hours it occur in children who seem to be metabolically returning to normal. (Pandey) Insulin was discovered in 1922, prior to, “the moratality due to DKA was virtually 100%. With the discovery of insulin, antiboiotics, intravenous potassium replacement and use of norepinephrine for blood pressure support, mortality rates ranging from 2.5% to 9% among patients admitted with DKA in more recent studies.” (Pandey)
“Cerebral Edema only occurs after initiation of therapy” Insulin therapy and others are associated with the onset of cerbral edema. (Pandey) There was a nurological study done to assess patients before and after insulin therapy in DKA. The study showed that the possible contibuting factor of this cerbral complication of DKA inlude hypoxia, the osmotically driven movement of water into the CNS when plasma osmolality declines too rapidly during the treatment of DKA. (Pandey)
Hypoglycemia, another complication due to DKA, is a reading of blood glucose below 70mg/dl. This particular complication can range from mild to severe with the potential to become fatal. “A mild episode typically produces adrenergic and cholinergic symptoms such as palpitations, tachycardia, apallor, sweating, paresthesias, shakiness, and hunger, However, patients are usually alert and able to treat themselves.” (Peragallo-Dittko)
While having a moderate episode of hypoglcemia, a patient’s concentration may become hinderd, he/she may experience confusion with the inability to make decisions for themselves. This happens when an individual is deprived of glucose, which...