Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis
| Autor: | Konstantine Xoinis, Prashant J. Purohit, Leon Grant, Hannah Kinoshita |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Weakness
Resuscitation Ataxia Diabetic ketoacidosis business.industry lcsh:Medical emergencies. Critical care. Intensive care. First aid Case Report 030209 endocrinology & metabolism lcsh:RC86-88.9 Emergency department Critical Care and Intensive Care Medicine medicine.disease Cerebral edema 03 medical and health sciences 0302 clinical medicine Anesthesia Dysmetria medicine Central pontine myelinolysis medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Case Reports in Critical Care, Vol 2018 (2018) Case Reports in Critical Care |
| ISSN: | 2090-6439 2090-6420 |
| DOI: | 10.1155/2018/4273971 |
| Popis: | Central pontine myelinolysis (CPM) is rarely reported in pediatric patients with diabetic ketoacidosis (DKA). We report this case of a 16-year-old female with new onset diabetes presenting with DKA, who received aggressive fluid resuscitation and sodium bicarbonate in the emergency department. Later she developed altered mental status concerning for cerebral edema and received hyperosmolar therapy with only transient improvement. Soon she became apneic requiring emergent endotracheal intubation. MRI brain showed cerebral edema, CPM, and subdural hemorrhage. She was extubated on day seven and exhibited mild dysmetria, ataxia, unilateral weakness, and neglect. Upon discharge she was able to ambulate with a walker and speak and eat without difficulty. Although less common than cerebral edema, CPM should be considered in DKA patients with acute neurologic deterioration. Fluid and bicarbonate therapy should be individualized, but larger studies would help guide the management. Although poor outcomes are reported in CPM, favorable outcomes are possible. |
| Databáze: | OpenAIRE |
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