Diabetic Treatment Sometimes Fatal

A routine treatment for children in diabetic crisis can trigger a rare complication that can kill them or cause brain damage, researchers say. <br><br>The study appears to confirm doctors' suspicions

Thursday, January 25th 2001, 12:00 am

By: News On 6

A routine treatment for children in diabetic crisis can trigger a rare complication that can kill them or cause brain damage, researchers say.

The study appears to confirm doctors' suspicions that giving bicarbonate to diabetic children to reverse a toxic acid buildup in their blood increases their risk of cerebral edema, or swelling of the brain.

The researchers recommended that doctors abandon the use of bicarbonate in most cases. Doctors should just give insulin to such children and, if needed, perform a procedure to draw water off the brain, they said.

The researchers also identified two risk factors that can help doctors spot children likely to develop such swelling.

The study focused on a diabetic crisis called diabetic ketoacidosis. It is an acid buildup that can occur if a child with Type 1, or insulin-dependent, diabetes misses an insulin injection, is hurt or becomes seriously ill.

The acid buildup can put a child into a coma within hours. Symptoms include excessive thirst and urination, vomiting, fatigue, abdominal pain, mental confusion and breath that smells like nail polish remover.

Swelling of the brain kills about one-fifth of these children and leaves an additional one-fourth with brain damage ranging from learning disabilities to a persistent vegetative state.

Dr. Nicole Glaser, an assistant pediatrics professor at the University of California-Davis School of Medicine, and colleagues in the United States and Australia looked at 6,977 children hospitalized for diabetic ketoacidosis between 1982 and 1997. Sixty-one had cerebral edema.

Children who got bicarbonate were 4.2 times more likely than the other youngsters to develop cerebral edema.

Those who developed cerebral edema were also found to be far more likely to have very low carbon dioxide and sharply higher nitrogen levels in their blood.

Children with those risk factors ``need to be very intensively monitored and aggressively treated'' with something other than bicarbonate, Glaser said.

The study was reported in Thursday's New England Journal of Medicine.

``It's a terrific piece'' of research, said Dr. Robert Goldstein, chief scientific officer of the Juvenile Diabetes Research Foundation. ``It can't help but have a positive influence.'' He said the level of carbon dioxide in particular ``tells you, `Aha! I really have to worry about this child.'''

In an accompanying editorial, however, Dr. David Dunger of the University of Cambridge and Dr. Julie Edge of John Radcliffe Hospital in Oxford, England, urged caution because other factors, such as the child's age and the severity of the diabetic ketoacidosis, could play a role in the development of cerebral edema.

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On the Net:

New England Journal of Medicine site: http://www.nejm.com

Juvenile Diabetes Research Foundation: http://www.jdrf.org

National Institute of Diabetes & Digestive & Kidney Diseases: http://www.niddk.nih.gov/index.htm