The impact of mannitol administration in pediatric DKA: A 22 year experience

Abstract

Objective: To describe circumstances and outcomes associated with mannitol administration in children being treated for diabetic ketoacidosis (DKA). Design: Retrospective chart review of consecutively admitted pediatric patients over a 22 year period (1988-2010). Setting: Data originate from three pediatric tertiary care centers where DKA was routinely treated during the study period with a physiologic approach to gradual rehydration, continuous IV insulin and intensive monitoring for symptomatic brain swelling. Mannitol was the drug of choice for suspected raised intracranial pressure (ICP). Patients: 941 consecutive patient episodes of moderate to severe DKA were reviewed for mannitol administration. Interventions: None Measurements and Main Results: Mannitol was administered during 76 of 941 episodes of DKA. Mannitol was successful 111 improving 01- reversing signs/symptoms of raised ICP 111 65% of mannitol recipients. No patient 111 this series suffered neurologic morbidity of mortality. Conclusions: Mannitol treatment for suspected raised ICP during treatment for DICA appears to be safe and beneficial to outcome when combined with careful rehydration, continuous insulin therapy, and cerebrovascular and biochemical monitoring.

Keywords

• diabetic ketoacidosis. children
• mannitol. fluid therapy. mortality
• cerebral edema