symptomatic cerebral oedema during treatment of diabetic ketoacidosis effect of adjuvant octreotide infusion糖尿病酮症酸中毒的症状性脑水肿治疗期间辅助octreotide灌注的影响.pdfVIP

Seewi et al. Diabetology Metabolic Syndrome 2010, 2:56 DIABETOLOGY /content/2/1/56 METABOLIC SYNDROME CASE REPORT Open Access Symptomatic cerebral oedema during treatment of diabetic ketoacidosis: effect of adjuvant octreotide infusion * Ora Seewi , Anne Vierzig, Bernhard Roth, Eckhard Schönau Abstract Introduction: A potentially lethal complication of diabetic ketoacidosis (DKA) in children is brain oedema, whether caused by DKA itself or by the therapeutic infusion of insulin and fluids. Case presentation: A 10-year old previously healthy boy with DKA became unconscious and apnoeic due to cerebral oedema (confirmed by abnormal EEG and CT-scan) during treatment with intravenous fluids (36 ml/h) and insulin (0.1 units/kg/h). He was intubated and artificially ventilated, without impact on EEG and CT-scan. Subsequently, adjuvant infusion of octreotide was applied (3.5 μg/kg/h), suppressing growth hormone (GH) and IGF-1 production and necessitating the insulin dose to be reduced to 0.05 - 0.025 units/kg/h. The brain oedema improved and the boy made a full recovery. Conclusion: Co-therapy with octreotide was associated with a favourable outcome in the present patient with DKA and cerebral oedema. Whether this could be ascribed to the effects of octreotide on the insulin requirement or on the GH/IGF-axis remains to be elucidated. Introduction DKA by Bosnak et al. [12]. These authors added a soma- Cerebral oedema is the most feared complication of tostatin infusion to the standard DKA therapy in two DKA. The pathogenesis appears co