FMGE 2023

Question 281: What is the most common cause of death in children with Diabetic ketoacidosis?

• A. Hypokalemia
• B. Cerebral edema (Correct Answer)
• C. Dehydration
• D. Sepsis

Explanation: ***Cerebral edema*** - It is the **most common cause of mortality** in pediatric DKA, occurring in 0.5-1% of cases with a mortality rate of 20-25% [1] - Occurs due to rapid changes in **plasma osmolality** during treatment - the rapid decrease of blood glucose and effective osmolarity creates an osmotic gradient, causing fluid shifts into brain cells - Leads to potentially fatal **intracranial pressure** elevation with clinical features of headache, altered mental status, bradycardia, and respiratory depression - Risk factors include: new-onset diabetes, younger age, severe acidosis, and rapid fluid administration *Hypokalemia* - Potassium levels often drop dramatically during DKA treatment as insulin drives potassium into cells, potentially causing life-threatening **cardiac arrhythmias** [1] - This complication is highly anticipated and routinely managed by **potassium replacement therapy** with close monitoring [3] - While potentially fatal if unrecognized, it is a **preventable and treatable** condition with proper electrolyte management *Dehydration* - Severe dehydration causing **hypovolemic shock** is a major factor contributing to morbidity in DKA [2] - Effectively managed by aggressive **IV fluid resuscitation** with careful monitoring [3] - In treated pediatric DKA, the failure leading to death is typically the development of **cerebral edema** rather than persistent volume depletion [1] *Sepsis* - While sepsis can precipitate DKA, it is an underlying **trigger** or precipitating factor, not the direct physiological cause of death during DKA itself - The overwhelming fatality **in** pediatric DKA (as opposed to from the precipitating illness) is generally attributed to **cerebral edema** from rapid fluid shifts leading to central nervous system complications [1]