INTRACRANIAL HYPERTENSION IN PATIENTS WIT H SEVERE DIABETIC-KETOACIDOSIS AND COMA - 2 CASE-REPORTS

We observed two cases of severe diabetic ketoacidosis with coma and sh ock In one case, coma was present at admission and in the second occur red within 15 hours. In both cases, intracranial hypertension was conf irmed with an extradural captor. These findings are in agreement with observations of brain oedema in diabetic ketoacidosis with coma. Clini cal data suggest that brain oedema may occur after a latency period bu t that clinical expression is much more rare, perhaps favoured by trea tment (excessive rehydratation, alkalinization, too sharp drop in bloo d glucose level). In our cases, despite major fluid infusion, shock pe rsisted requiring norepinephrine. This shock could have been the expre ssion of the severe ketoacidosis or have resulted from an underlying i nfection. In case of sudden onset coma, a regularly encountered manife station of brain oedema, respiratory assistance and mannitol infusion must be instituted rapidly. With this type of management, it should be possible to improve the severe prognosis of brain oedema in diabetic ketoacidosis.