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Table 6 Studies on risk of cerebral edema in pediatric DKA population

From: Bicarbonate in diabetic ketoacidosis - a systematic review

References Trial design Case (children with CE) Control(s) Associated risks of CE Bicarb therapy and CE risk
Glaser et al. [25] Retrospective N = 61 N = 174 (matched) Higher urea nitrogen and lower arterial PCO2 levels Bicarb therapy significantly a/w CE (matched control)
NEJM 2001 case-control Mean age: 8.9 yr Mean age: 9.0 yr at presentation (matched and random controls) (23 of 61 with CE received bicarb;
  (multicenter) Mean pH: 7.06 Mean pH: 7.09 and vs. 43 of 174 matched controls);
  USA + Australia (matched for age, DM onset, pH/bicarb, glucose) smaller increase in Na+ (matched control) RR 4.2 (p = 0.008)
    N = 181 (random) and  
    Mean age: 11.3 yr Younger age, newly dx DM, lower pH, higher  
    Mean pH: 7.12 glucose & Cr at presentation (random control)  
Lawrence et al. [26] Prospective + N = 21 N = 42 (mostly random) Lower bicarb, higher urea, higher glucose levels Trend towards association for bicarb therapy with CE
J Pediatrics 2005 Retrospective Mean age: 9.0 yr Mean age: 9.6 yr at presentation (data for bicarb therapy available in 17 CE cases,
  case-control Mean pH: 7.10 Mean pH: 7.20   with 34 random controls)
  (multicenter) (13 prospective, (matched for institution   
  Canada 8 retrospective) and data collection duration)   
Edge et al. [27] Prospective N = 43 N = 169 Lower pH and/or lower bicarb levels, higher urea Unadjusted OR of bicarb Rx for CE risk of 3.7 (p < 0.05)
Diabetologia 2006 case-control Mean age: 8.5 yr Mean age: 8.9 yr and potassium levels at presentation; After adjustments for matching variables and baseline
  (multicenter) Mean pH: 7.00 Mean pH: 7.20 more cumulative fluid volume given in 1st 4 hr, acidosis, OR reduced to 1.5 (not significant)
  United Kingdom (matched for age, sex, DM onset, admission month) insulin administration in 1st hr, and higher quantity  
     of insulin given over 1st 2 hr  
  1. DM = diabetes mellitus; bicarb = bicarbonate; Na+ = sodium; Cr = creatinine; CE = cerebral edema; neuro = neurological; RR = relative risk; OR = odds ratio; Rx = treatment