Overview of Cerebral Edema During Correction of Hyperglycemic Crises.

Content Provider	Europe PMC
Author	Varela, Daniel Held, Natalie Linas, Stuart
Copyright Year	2018
Abstract	Patient: Male, 31Final Diagnosis: Mixed diabetic ketoacidosis and hyperglycemic hyperosmolar stateSymptoms: Acute encephalopathy and motor polyneuropathyMedication: Normal saline boluses followed by half-normal saline infusion • insulin dripClinical Procedure: —Specialty: Critical Care • Endocrine • Nephrology • NeurologyObjective:Unusual or unexpected effect of treatmentBackground:Hyperglycemic crises can cause severe neurologic impairment. One of the most dreaded consequences of hyperglycemic crises is cerebral edema, a rare complication seen during the treatment of hyperglycemic crises resulting from overly-aggressive fluid resuscitation and rapid correction of hyperglycemia and hyperosmolarity.Case Report:We present a case of profound hyperglycemic crisis with blood glucose greater than 2000 mg/dL, complicated by the development of new neurologic deficits after rapid correction of hyperglycemia. Brain imaging failed to reveal a diagnosis of cerebral edema or other acute intracranial process. However, the deficits did not resolve by the time of discharge, raising concern that the neurologic impairment may have been the consequence of overly-aggressive treatment of the hyperglycemic crisis.Conclusions:Neurologic status must be monitored closely, with frequent re-examination, in patients who present with hyperglycemic crises. Care should be taken to prevent over-correction of hyperglycemia and hyperosmolarity following initial fluid resuscitation of these patients to prevent cerebral edema or other significant neurologic impairment.
Volume Number	19
PubMed Central reference number	PMC5983073
PubMed reference number	29760374
Journal	The American Journal of Case Reports [Am J Case Rep]
e-ISSN	19415923
DOI	10.12659/AJCR.908465
Language	English
Publisher	International Scientific Literature, Inc.
Publisher Date	2018-05-15
Access Restriction	Open
Rights License	This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) © Am J Case Rep, 2018
Subject Keyword	Brain Edema Diabetic Ketoacidosis Hyperglycemia Hyperglycemic Hyperosmolar Nonketotic Coma Hypernatremia
Content Type	Text
Resource Type	Article
Subject	Medicine