Audio 1_When diabetic ketoacidosis becomes a neurological emergency: cerebral edema in a child with new-onset type 1 diabetes mellitus - a case report and narrative review.mp3

On admission, the boy was in severe general condition. Severe DKA was confirmed (pH 6.88), and appropriate treatment was implemented, resulting in temporary clinical stabilization. However, on the second day of hospitalization, the patient’s condition deteriorated again.

He was somnolent, with fluctuating consciousness and nuchal rigidity. An increase in intracranial pressure (ICP) was suspected. Optic nerve ultrasonography revealed increased optic nerve sheath diameters, also suggestive of raised ICP.

Anti-edema therapy with mannitol was initiated based on clinical suspicion, resulting in clinical improvement. Dexamethasone and furosemide were administered as adjunctive therapy. Subsequent CT findings supported the diagnosis of CE.

The patient was discharged after 10 days in good general condition.</p>Conclusions<p>DKA can be a diagnostic challenge for clinicians due to its nonspecific symptoms. Early signs suggesting this condition should not be underestimated, and bedside blood glucose should be measured early in children presenting with unexplained vomiting, weight loss, tachypnea, dehydration or altered consciousness. Close monitoring for complications is critical during treatment, especially for CE, one of the most serious and potentially life-threatening consequences of DKA.</p>