Krane E J, Rockoff M A, Wallman J K, Wolfsdorf J I
N Engl J Med. 1985 May 2;312(18):1147-51. doi: 10.1056/NEJM198505023121803.
Clinically apparent cerebral edema is a rare and often fatal complication of diabetic ketoacidosis. To determine whether subclinical brain swelling occurs more commonly, we obtained cranial CT scans in six children with diabetic ketoacidosis treated with fluid resuscitation and continuous low-dose insulin therapy. Control scans were obtained before hospital discharge. Compared with the scans during convalescence, the early scans of all six children showed a narrowing of the brain's ventricular system, compatible with brain swelling. Average changes in diameter were 1.3 +/- 0.1 mm for the third ventricle and 3.7 +/- 0.8 mm for the lateral ventricles (P less than 0.01). In addition, a narrowing of the subarachnoid spaces was subjectively noted during a blind reading of the early scans. Although no single scan was overtly indicative of cerebral edema, the data suggest that subclinical brain swelling may be a common occurrence during treatment of diabetic ketoacidosis in children. Sequential CT scans of the brain may provide a means of evaluating modifications of standard therapy aimed at preventing cerebral edema.
临床上明显的脑水肿是糖尿病酮症酸中毒一种罕见且常致命的并发症。为了确定亚临床脑肿胀是否更常见，我们对6例接受液体复苏和持续小剂量胰岛素治疗的糖尿病酮症酸中毒患儿进行了头颅CT扫描。在出院前进行对照扫描。与恢复期扫描相比，所有6例患儿的早期扫描均显示脑室系统变窄，符合脑肿胀表现。第三脑室直径平均变化为1.3±0.1mm，侧脑室为3.7±0.8mm（P<0.01）。此外，在对早期扫描进行盲法读片时主观上注意到蛛网膜下腔变窄。虽然没有单次扫描明显提示脑水肿，但数据表明亚临床脑肿胀可能是儿童糖尿病酮症酸中毒治疗期间的常见现象。对大脑进行连续CT扫描可能为评估旨在预防脑水肿的标准治疗的调整提供一种方法。
