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

Glaser et al. [25]

Retrospective

N = 61

N = 174 (matched)

Higher urea nitrogen and lower arterial P_CO2 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