were other interesting trends noted in the study, which were not significantly
significant (most likely due to small sample size.) The rate decline
in both Na+ and glucose during treatment was greater in the affected
group than in non-affected group.
The theory behind using caution during IVF administration is that overly
rapid fluid re-hydration in DKA can cause a rapid decline in serum glucose,
and thus cause fluid shifts from the extra-cellular to the intra-cellular
compartment, causing cerebral edema, which can lead to brain herniation.
work has been done which suggests that a "negative sodium trend" (i.e.,
a decline in corrected serum Na+ level) during DKA management is also
a predictor of brain herniation. In fact, in their series, by monitoring
serum Na+, by using slow re-hydration, and by adjusting Na+ concentration
in IVF to prevent a negative sodium trend, they had zero episodes of
brain herniation (of 231 episodes of DKA).(2)
was no increase in non-cerebral complications of dehydration in the
patients who were re-hydrated modestly, as opposed to being re-hydrated
Mahoney CP. Vicek BW. DelAguila M. Risk factors for developing brain
herniation during dibetic ketoacidosis. Pediatric Neurology 1999;
Harris GD. Fiordalisi I. Physiologic Management of diabetic ketoacidemia.
A 5-year prospective pediatric experience in 2331 episodes. Archives
of Pediatrics & Adolescent Medicine 1994; 148(10):1046-52.
The Harriet Lane Handbook, 15th edition. Siberry GK. Iannone R. pp 207-209.