Table 1

Summary of available evidence relating treatment of diabetic ketoacidosis to development of cerebral oedema

PaperNumberMethodsConclusions
Harris et al, 1990 3 219 DKA cases. 58 DKA casesRetrospective chart review Prospective interventional studySodium trend may correlate with DKA risk
Glaser et al 2001 5 6977 DKA cases. 61 CO casesRetrospective case-controlCO risk not related to fluids or insulin
Rosenbloom 1990 6 69 CO casesCase seriesCO risk not related to treatment
Mahoney et al 1999 8 195 DKA cases. 9 CO casesRetrospective chart reviewFluid administration associated with CO risk
Vlcek 1986 4 5 CO cases. 15 controlsRetrospective case-controlCO risk related to fluids
Duck et al 1976 9 4 CO casesCase seriesTreatments may be related to CO risk
Duck, Wyatt 1988 10 42 CO casesCase seriesCO risk may be related to fluids
Harris, Fiordalisi 1994 11 231 DKA cases. Zero CO casesProspective studyConservative treatment may reduce risk for CO
Bello, Sotos 1990 13 11 CO cases. 20 controlsRetrospective case-controlCO in DKA may have osmolar cause
Durr et al 1992 29 7 DKA cases. Zero clinical CO casesCT evidence of CO correlated to change in osmolalityCO may exist before treatment, but may worsen with aggressive treatment
Krane et al 1995 14 6 DKA cases. Zero clinical CO casesObservational report of serial CT scans during treatmentSubclinical cases of CO may be common during treatment
Clements et al 1971 15 5 DKA cases. Zero clinical CO casesCSF pressure monitored continuously during treatmentIncreased CSF pressure may be common during treatment
Rosenbloom et al 1980 18 17 CO casesCase seriesCO risk not related to treatment
Hoffman et al 1988 21 9 DKA cases. Zero CO casesObservational report of serial CT scans during treatmentCerebral swelling is usually present before treatment
Mel, Werther 1995 22 6 CO of 3134 DKA. 6 CO of 3373 DKARetrospective comparison of two different treatment cohortsCO risk not related to treatment
Edge, Dunger 1994 23 25 management protocolsProtocols evaluated for outcome differencesAggressive treatment may increase CO risk
Felner, White 2001 24 520 DKA cases. 0.3–0.5% CO rateRetrospective comparison of two different treatment cohortsCO risk similar in the two protocols
Fein et al 1982 25 18 DKA cases. Zero CO casesSerial echoencephalograms during treatmentCO risk may be related to treatment
Smedman et al 1997 26 8 DKA casesObservational report of serial CT scans during treatmentSubclinical CO does not occur regularly during DKA treatment
Hale et al 1997 27 4 CE cases. 10 controlsRetrospective case-controlCO may be related to declining sodium
Edge et al 2001 28 2940 DKA cases. 34 CO casesLarge descriptive study producing risk estimatesCO is an important complication of DKA