Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.167
Peer-review started: August 30, 2014
Revised: October 31, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 15, 2015
The incidence of type 1 diabetes (T1D) among youth is steadily increasing across the world. Up to a third of pediatric patients with T1D present with diabetic ketoacidosis, a diagnosis that continues to be the leading cause of death in this population. Cerebral edema is the most common rare complication of diabetic ketoacidosis in children. Accordingly, treatment and outcome measures of cerebral edema are vastly researched and the pathophysiology is recently the subject of much debate. Nevertheless, cerebral edema is not the only sequela of diabetic ketoacidosis that warrants close monitoring. The medical literature details various other complications in children with diabetic ketoacidosis, including hypercoagulability leading to stroke and deep vein thrombosis, rhabdomyolysis, pulmonary and gastrointestinal complications, and long-term memory dysfunction. We review the pathophysiology, reported cases, management, and outcomes of each of these rare complications in children. As the incidence of T1D continues to rise, practitioners will care for an increasing number of pediatric patients with diabetic ketoacidosis and should be aware of the various systems that may be affected in both the acute and chronic setting.
Core tip: Diabetic ketoacidosis is highly prevalent in pediatric patients with both newly diagnosed and established type 1 diabetes. The most common rare complication is cerebral edema, which is the leading cause of death in youth with diabetes. However, several other complications involving multiple systems have been described and can cause significant morbidity in cases of pediatric diabetic ketoacidosis, thus warranting awareness and targeted monitoring.