Overview of Cerebral Edema During Correction of Hyperglycemic Crises

Patient: Male, 31 Final Diagnosis: Mixed diabetic ketoacidosis and hyperglycemic hyperosmolar state Symptoms: Acute encephalopathy and motor polyneuropathy Medication: Normal saline boluses followed by half-normal saline infusion • insulin drip Clinical Procedure: — Specialty: Critical Care • Endocrine • Nephrology • Neurology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Hyperglycemic crises can cause severe neurologic impairment. One of the most dreaded consequences of hyperglycemic crises is cerebral edema, a rare complication seen during the treatment of hyperglycemic crises resulting from overly-aggressive fluid resuscitation and rapid correction of hyperglycemia and hyperosmolarity. CASE REPORT: We present a case of profound hyperglycemic crisis with blood glucose greater than 2000 mg/dL, complicated by the development of new neurologic deficits after rapid correction of hyperglycemia. Brain imaging failed to reveal a diagnosis of cerebral edema or other acute intracranial process. However, the deficits did not resolve by the time of discharge, raising concern that the neurologic impairment may have been the consequence of overly-aggressive treatment of the hyperglycemic crisis. CONCLUSIONS: Neurologic status must be monitored closely, with frequent re-examination, in patients who present with hyperglycemic crises. Care should be taken to prevent over-correction of hyperglycemia and hyperosmolarity following initial fluid resuscitation of these patients to prevent cerebral edema or other significant neurologic impairment.