期刊
PEDIATRIC DIABETES
卷 22, 期 2, 页码 148-160出版社
WILEY
DOI: 10.1111/pedi.13152
关键词
brain injury; cerebral edema; diabetes mellitus; diabetic ketoacidosis; pediatrics
资金
- National Institute of Diabetes and Digestive and Kidney Diseases [5T32DK007699-39]
Cerebral edema is a potentially devastating complication of diabetic ketoacidosis that mainly occurs in children. Despite numerous identified risk factors, there is uncertainty surrounding the mechanisms leading to its development. The most widely accepted hypothesis posits that CE occurs as a result of ischemia-reperfusion injury.
Cerebral edema (CE) is a potentially devastating complication of diabetic ketoacidosis (DKA) that almost exclusively occurs in children. Since its first description in 1936, numerous risk factors have been identified; however, there continues to be uncertainty concerning the mechanisms that lead to its development. Currently, the most widely accepted hypothesis posits that CE occurs as a result of ischemia-reperfusion injury, with inflammation and impaired cerebrovascular autoregulation contributing to its pathogenesis. The role of specific aspects of DKA treatment in the development of CE continues to be controversial. This review critically examines the literature on the pathophysiology of CE and attempts to categorize the findings by types of brain injury that contribute to its development: cytotoxic, vasogenic, and osmotic. Utilizing this scheme, we propose a multifactorial pathway for the development of CE in patients with DKA.
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