Education And Debate

Late diagnosis of diabetic ketoacidosis and underlying disease influence response to treatment

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7073.63 (Published 04 January 1997) Cite this as: BMJ 1997;314:63
  1. P J Manning, consultant endocrinologista,
  2. W Sutherland, research fellowa,
  3. J I Mann, professor in human nutrition and medicinea
  1. a Department of Medicine, University of Otago Medical School, Dunedin, New Zealand

    Commentary

    This patient with diabetic ketoacidosis has the chylomicronaemia syndrome with plasma triglyceride concentrations in excess of about 45 mmol/l as judged by the presence of lipaemia retinalis. In addition, cerebral oedema, lactic acidosis, pancreatitis, and sepsis may also be present.

    A reduced level of consciousness in a child with diabetic ketoacidosis may indicate the presence of cerebral oedema. The potential consequences of cerebral oedema justify immediate administration of intravenous mannitol followed by computed tomography or magnetic imaging resonance scanning of the brain to confirm or refute this diagnosis. The diabetic ketoacidosis should be managed in the usual manner with particular attention paid to maintaining optimal fluid balance and glucose control. …

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