CENTRAL DIABETES INSIPIDUS IN PEDIATRIC SEVERE TRAUMATIC BRAIN INJURY

Alharfi IM, Stewart TC, Foster J, Morrison GC, Fraser DD. Pediatr Crit Care Med. 2013;14(2):203-209.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children with central diabetes inspidus (CDI) complication. The researchers in this retrospective chart and imaging review sought to determine the incidence rate of CDI in pediatric patients with TBI and to describe the clinical injury, biochemical, imaging, and intervention variables associated with mortality at a level 1 pediatric trauma center.

Of 818 patients admitted to the pediatric critical care unit, 180 were identified as having TBI, with an overall mortality rate of 27.2% for all TBI, and 32 of these patients developed CDI. At the time of CDI diagnosis, median urine output was 6.8 mL/kg/h and serum sodium level was 154 mmol/L. The mortality rate of CDI patients was 87.5%. Factors associated with mortality included early CDI onset within the first 2 days (P < .001), lower Glasgow Coma Scale score (P = .03), occurrence of fixed pupils (P = .04), and prolonged partial thromboplastin time (P = .04). Cerebral edema on the initial computed tomography within 24 hours of injury was associated with death (P = .002). Survivors of CDI were more likely to have intracranial monitoring (P = .03), have thiopental administered to induce coma (P = .04), and have received a decompressive craniotomy for increased intracranial pressure (P = .04).

The authors concluded the outcome of CDI after TBI was an 18% incidence of occurrence and 87.5% mortality. The mortality was 100% for TBI patients who developed CDI during the first 2 days after a TBI. Intracranial pressure monitoring, thiopental coma, and decompressive craniotomy were associated with survival.

COAGULATION ASSESSMENT IN CHILDREN WITH DIABETIC KETOACIDOSIS

Tran HT, Al-Harfi I, Harle CC, Kahr WHA, Morrison GC, Kornecki A. Pediatr Crit Care Med. 2013;14(3):256-260.

This prospective controlled pilot study sought to assess potential hypercoagulability during diabetic ketoacidosis (DKA) in children in a university-affiliated pediatric critical care unit and emergency department at a children's hospital. The authors hypothesized that the potential hypercoagulabilty during DKA may be assessed by thromboelastography. The subjects were children admitted with an episode of DKA (n = 15) and healthy children as controls (n = 20).

The researchers found that the values for standard thromboelastography parameters in the DKA group on admission and resolution were within the control range. They also found that the thromboelastography profiles of DKA patients on admission were not significantly different from profiles upon DKA resolution. They found that the mean [alpha] angle was significantly higher in known diabetes patients compared with newly diagnosed diabetes patients on admission.

The authors concluded that this study group of pediatric patients with DKA thromboelastography was not consistent with hypercoagulabilty. The identified that further investigations are required to examine potential nonintrinsic etiology of the suspected hypercoagulability associated with DKA.