MMPAD Milan Meeting Report

10 European Roadshow - Milan, 29 June 2018 MEETING REPORT It is also fundamental to know the risk factors for cerebral oedema : 11 • High creatininaemia at diagnosis • Severe acidosis at onset • Excessive and rapid alkalisation • High levels of sodium corrected at the beginning of treatment • Lack of sodium increase during treatment • Hyperhydration in the first hours of treatment • Rapid reduction of blood sugar and acidosis • Insulin administration in the first hours of treatment Management of cerebral oedema requires : 11 • Start of treatment if diagnosis is suspected • Administration of mannitol 18% ev, at a dose of 0.5-1 g/kg, in 20-30 minutes, with repetition after 2 hours if necessary • 1 / 3 reduction of liquid infusion • In case of non-response to mannitol, administer hypertonic saline solution (3%), 2.5-5 g/ kg in 10-15 minutes • Intubation and artificial ventilation, if necessary • Cerebral CT scan, after treatment, to evaluate other possible causes (thrombosis, haemorrhage, cerebral infarction) A recent work by Kupperman assessed the infusion of fluids in paediatric DKA, highlighting how neither infusion rate nor sodium content correlates with acute and chronic CNS complications, but modulating the infusion rate of liquids is important for correcting cardiovascular parameters . 12