Risk of cerebral edema in children with diabetic ketoacidosis in the course of type 1 diabetes

Diabetic ketoacidosis (DKA) is the most common acute complication of type 1 diabetes mellitus (T1DM) in children. Among all acute complications of T1DM, DKA is a complication with the greatest risk of cerebral edema. The aim of this article was to present current research on the assessment of the risk of cerebral edema in patients with diabetic ketoacidosis in the course of T1DM. The development of DKA in T1DM is associated with rapid changes in osmolarity and the reduction of the brain tissue perfusion and decreased diffusion coefficient due to the dominance of the extracellular fluid or the impact of increased amounts of ketones on the endothelium. The assessment of the patient’s neurological status is the primary measure aimed at early detection of cerebral edema in patients with DKA. As well, neuroimaging studies including CT and MRI are helpful in detecting brain edema but sometimes they can be too invasive and do not clearly correlate with the patient’s clinical state. The assessment of dynamic changes in interleukin-1 and interleukin-8 concentrations in diabetic ketoacidosis at diagnosis and during the treatment of patients can also help to evaluate the risk of neurological complications and find the way to prevent them. Even a very careful observation of the patient with T1DM and ketoacidosis and an appropriate diagnosis and therapy do not allow for the exclusion of brain edema. These facts lead to the search for new biomarkers that allow for early assessment of the risk of cerebral edema.