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Objectives: To determine incidence, outcomes, and risk factors for pediatric c erebral edema with diabetic ketoacidosis (CEDKA) in Canada. Study design: This w as a case-control study nested within a population-based active surveillance s tudy of CEDK A in Canada from July 1999 to June 2001. Cases are patients with DK A <16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema. Results: Thirteen cases of CEDKA w ere identified over the surveillance period for an incidence rate of 0.51%; 23 %died and 15%survived with neurologic sequelae. CEDKA was present at initial p resentation of DKA in 19%of cases. CEDKA was associated with lower initial bica rbonate (P =. 001), higher initial urea (P =. 001), and higher glucose at presen tation (P =. 014). Although there was a trend to association with higher fluid r ates and treatment with bicarbonate, these were not independent predictors. Conc lusions: CEDKA remains a significant problem with a high mortality rate. No asso ciation was found between the occurrence of CEDKA and treatment factors. The pre sence of cerebral edema before treatment of DKA and the association with severit y of illness suggest that prevention of DKA is the key to avoiding this devastat ing complication.
Objectives: To determine the incidence, outcomes, and risk factors for pediatric cerebral edema with diabetic ketoacidosis (CEDKA) in Canada. Study design: This w as a case-control study nested within a population-based active surveillance trial of CEDK A in Canada from July 1999 to June 2001. Cases are patients with DK A <16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema. Results: Thirteen cases of CEDKA identified over the surveillance period CEDKA was associated with lower initial bica rbonate (P = .001), higher than 0.51%; 23% died and 15% survived with neurologic sequelae. CEDKA was present at initial p resentation of DKA in 19% of cases. Although there was a trend to association with higher fluid r ates and treatment with bicarbonate, these were not independent predictors. Conc lusions: CEDKA remains (P =. 001) a significant p roblem with a high mortality rate. No asso ciation was found between the occurrence of CEDKA and treatment factors. The pre sence of cerebral edema before treatment of DKA and the association with severit y of illness suggest that prevention of DKA is the key to avoiding this devastat ing complication.