{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:03Z","timestamp":1790575023239,"version":"4.1.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1D), potentially leading to severe outcomes, including cerebral edema (CE). The case describes an eight-year-old child with previously undiagnosed T1D complicated by DKA, and subsequent development of CE. It is followed by a short literature review including other pediatric cases of clinically overt CE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A boy was admitted to the outpatient clinic with a several-day history of vomiting, abdominal pain and headache, leading to a presumptive diagnosis of gastrointestinal infection. The following day, the patient\u2019s condition deteriorated. Despite a positive family history of T1D (the patient\u2019s father), his blood glucose level was measured for the first time by the emergency medical service (25.6 mmol\/L (460 mg\/dL)). Further evaluation revealed DKA secondary to previously undiagnosed T1D. 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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1921269","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:43:26Z","timestamp":1790574206000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["When diabetic ketoacidosis becomes a neurological emergency: cerebral edema in a child with new-onset type 1 diabetes mellitus -\u00a0a case report and narrative review"],"prefix":"10.3389","volume":"17","author":[{"given":"Mateusz","family":"Okonek","sequence":"first","affiliation":[{"name":"Student Scientific Circle of Pediatrics, Diabetology and Endocrinology, Faculty of Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]},{"name":"Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Paczkowska","sequence":"additional","affiliation":[{"name":"Student Scientific Circle of Pediatrics, Diabetology and Endocrinology, Faculty of Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinga","family":"Drzewi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrycja","family":"Rozwadowska-Kunecka","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Wo\u0142oszyn-Durkiewicz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gda\u0144sk","place":["Gda\u0144sk, Poland"]},{"name":"Department of Pediatrics, Diabetology and Endocrinology, Faculty of Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rados\u0142aw","family":"Owczuk","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]},{"name":"Department of Anesthesiology and Intensive Therapy, University Clinical Center in Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"My\u015bliwiec","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gda\u0144sk","place":["Gda\u0144sk, Poland"]},{"name":"Department of Pediatrics, Diabetology and Endocrinology, Faculty of Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-001-0009-7","article-title":"Cerebral edema in children with diabetic ketoacidosis","volume":"1","author":"Glaser","year":"2001","journal-title":"Curr Diabetes Rep"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/00008480-200206000-00001","article-title":"Diabetic ketoacidosis and cerebral edema","volume":"14","author":"Bohn","year":"2002","journal-title":"Curr Opin Pediatr"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12155","article-title":"How can cerebral edema during treatment of diabetic ketoacidosis be avoided","volume":"15","author":"Watts","year":"2014","journal-title":"Pediatr Diabetes"},{"key":"B4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1136\/adc.85.1.16","article-title":"The risk and outcome of cerebral oedema developing during diabetic ketoacidosis","volume":"85","author":"Edge","year":"2001","journal-title":"Arch Dis Child"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13152","article-title":"Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral edema","volume":"22","author":"Azova","year":"2021","journal-title":"Pediatr Diabetes"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1056\/nejm200101253440404","article-title":"Risk factors for cerebral edema in children with diabetic ketoacidosis","volume":"344","author":"Glaser","year":"2001","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2019.04.013","article-title":"Is age a risk factor for cerebral edema in children with diabetic ketoacidosis? A literature review","volume":"44","author":"Glackin","year":"2020","journal-title":"Can J Diabetes"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.1960","article-title":"Subclinical cerebral edema in diabetic ketoacidosis in children","volume":"7","author":"Agarwal","year":"2018","journal-title":"Clin Case Rep"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13406","article-title":"ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","author":"Glaser","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/S00381-016-3067-5","article-title":"The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children: Part I: repeatability, observer variability and general analysis","volume":"32","author":"Padayachy","year":"2016","journal-title":"Childs Nerv Syst"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2022.3586","article-title":"Factors associated with diabetic ketoacidosis at onset of type 1 diabetes among pediatric patients: A systematic review","volume":"176","author":"Rugg-Gunn","year":"2022","journal-title":"JAMA Pediatr"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13379","article-title":"Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak-Two-year cross-sectional national observation by PolPeDiab Study Group","volume":"23","author":"Pietrzak","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.2337\/dc20-0389","article-title":"Increase in prevalence of diabetic ketoacidosis at diagnosis among youth with type 1 diabetes: The SEARCH for Diabetes in Youth Study","volume":"44","author":"Jensen","year":"2021","journal-title":"Diabetes Care"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15779","article-title":"Follow-up and monitoring programme in children identified in early-stage type 1 diabetes during screening in the general population of Italy","volume":"26","author":"Cherubini","year":"2024","journal-title":"Diabetes Obes Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/4238394","article-title":"Detection of islet autoantibodies in whole blood by antibody detection by agglutination-PCR (ADAP) technology is sensitive and suitable for general population screening programs","volume":"2024","author":"Oron","year":"2024","journal-title":"Pediatr Diabetes"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/dme.15419","article-title":"Protocol for the Australian Type 1 Diabetes National Screening Pilot: Assessing the feasibility and acceptability of three general population screening models in children","volume":"41","author":"Bell","year":"2024","journal-title":"Diabetes Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1159\/000543035","article-title":"ISPAD Clinical Practice Consensus Guidelines 2024: Screening, staging, and strategies to preserve beta-cell function in children and adolescents with type 1 diabetes","volume":"97","author":"Haller","year":"2024","journal-title":"Horm Res Paediatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000551858","article-title":"Polish recommendations for the early detection of type 1 diabetes in the pediatric population: A position statement of the Polish Society of Pediatric Endocrinology and Diabetology and the Pediatric Section of the Diabetes Poland 2026","author":"Chobot","year":"2026","journal-title":"Horm Res Paediatr"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.108838","article-title":"Effectiveness of ketoacidosis prevention campaigns at diagnosis of type 1 diabetes in children: A systematic review and meta-analysis","volume":"175","author":"Cherubini","year":"2021","journal-title":"Diabetes Res Clin Pract"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14121115","article-title":"Diabetes awareness campaigns to prevent ketoacidosis at the diagnosis of type 1 diabetes: Efficacy on multiple outcomes and predictors of success: A systematic review","volume":"14","author":"Minerba","year":"2024","journal-title":"J Pers Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.inat.2025.102091","article-title":"Ultrasound measurement of optic nerve sheath diameter for intracranial pressure monitoring","volume":"41","author":"Jiang","year":"2025","journal-title":"Interdiscip Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2026.1785962","article-title":"Ultrasonographic optic nerve sheath diameter as a non-invasive marker of intracranial hypertension in pediatric patients: a pilot study","volume":"14","author":"Montero-Y\u00e9boles","year":"2026","journal-title":"Front Pediatr"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.2337\/diab.23.5.405","article-title":"Metabolic effects of sodium bicarbonate in management of diabetic ketoacidosis","volume":"23","author":"Assal","year":"1974","journal-title":"Diabetes"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13247822","article-title":"Complexities, benefits, risks, and clinical implications of sodium bicarbonate administration in critically ill patients: A state-of-the-art review","volume":"13","author":"Eraky","year":"2024","journal-title":"J Clin Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1080\/13102818.2016.1221740","article-title":"Risk factors for cerebral oedema in children and adolescents with diabetic ketoacidosis","volume":"30","author":"Yaneva","year":"2016","journal-title":"Biotechnol Biotechnol Equip"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2023.04.012","article-title":"A review of bicarbonate use in common clinical scenarios","volume":"65","author":"Wardi","year":"2023","journal-title":"J Emergency Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.ajem.2025.07.033","article-title":"Reevaluating bicarbonate therapy in pediatric DKA: A propensity score-matched analysis of neurological and respiratory outcomes","volume":"97","author":"Patel","year":"2025","journal-title":"Am J Emergency Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.5114\/ctd\/203685","article-title":"Zalecenia kliniczne dotycz\u0105ce post\u0119powania u os\u00f3b z cukrzyc\u0105 \u2013 2025. Stanowisko Polskiego Towarzystwa Diabetologicznego","volume":"5","author":"Araszkiewicz","year":"2025","journal-title":"Curr Top Diabetes"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.amj.2014.10.009","article-title":"The lethargic diabetic: Cerebral edema in pediatric patients in diabetic ketoacidosis","volume":"34","author":"Gee","year":"2015","journal-title":"Air Med J"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1159\/000382016","article-title":"Cerebral accidents in pediatric diabetic ketoacidosis: Different complications and different evolutions","volume":"84","author":"Mozzillo","year":"2015","journal-title":"Horm Res Paediatr"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1515\/jpem-2015-0481","article-title":"A fatal outcome of complicated severe diabetic ketoacidosis in a 11-year-old girl","volume":"29","author":"Severinski","year":"2016","journal-title":"J Pediatr Endocrinol Metab"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-015-1961-6","article-title":"Acute respiratory distress syndrome: A rare complication in pediatric diabetic ketoacidosis","volume":"83","author":"Sudhanshu","year":"2016","journal-title":"Indian J Pediatr"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13328","article-title":"Hyperglycaemia-related complications at the time of diagnosis can cause permanent neurological disability in children with neonatal diabetes","volume":"34","author":"Day","year":"2017","journal-title":"Diabetes Med"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.5374","article-title":"Peripheral neuropathy as a complication of diabetic ketoacidosis in a child with newly diagnosed diabetes type 1: A case report","volume":"10","author":"Baszy\u0144ska-Wilk","year":"2018","journal-title":"J Clin Res Pediatr Endocrinol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.24953\/turkjped.2017.03.014","article-title":"Alpha coma in an adolescent with diabetic ketoacidosis","volume":"59","author":"Ostojic","year":"2017","journal-title":"Turk J Pediatr"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1177\/2050313x19847797","article-title":"Myocardial dysfunction associated with diabetic ketoacidosis in a 5-year-old girl","volume":"7","author":"Halloum","year":"2019","journal-title":"SAGE Open Med Case Rep"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1111\/ped.13973","article-title":"Prednisolone therapy in prolonged cerebral edema due to diabetic ketoacidosis","volume":"61","author":"Yoshizawa","year":"2019","journal-title":"Pediatr Int"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1515\/jpem-2019-0440","article-title":"Can we effectively predict the occurrence of cerebral edema in children with ketoacidosis in the course of type 1 diabetes? - case report and literature review","volume":"33","author":"Jeziorny","year":"2020","journal-title":"J\u00a0Pediatr Endocrinol Metab"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-241690","article-title":"Cerebral oedema and dural sinus thrombosis in an adolescent with diabetic ketoacidosis","volume":"14","author":"Bassell","year":"2021","journal-title":"BMJ Case Rep"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1097\/ms9.0000000000003332","article-title":"Diabetic ketoacidosis and cerebral edema: a rare case of infarct-like MRI findings in a pediatric patient","volume":"87","author":"Kachuei","year":"2025","journal-title":"Ann Med Surg (Lond)"},{"key":"B41","first-page":"89","article-title":"A pediatric diabetic ketoacidosis patient with multisystem complications and a prolonged course","volume-title":"Kans J Med","author":"Carson","year":"2019"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2006.01.010","article-title":"Cerebral venous thrombosis as a first presentation of diabetes","volume":"35","author":"Sasiadek","year":"2006","journal-title":"Pediatr Neurol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.4061\/2011\/219706","article-title":"Diabetic ketoacidosis-associated stroke in children and youth","volume":"2011","author":"Foster","year":"2011","journal-title":"Stroke Res Treat"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12760","article-title":"Subarachnoid and parenchymal haemorrhages as a complication of severe diabetic ketoacidosis in a preadolescent with new onset type 1 diabetes","volume":"19","author":"Finn","year":"2018","journal-title":"Pediatr Diabetes"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12362","article-title":"Posterior reversible encephalopathy syndrome complicating diabetic ketoacidosis; an important treatable complication","volume":"18","author":"Jones","year":"2017","journal-title":"Pediatr Diabetes"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3390\/reports9010027","article-title":"Case report of overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state in a 5-year-old with new-onset type 1 diabetes mellitus: Diagnostic and management considerations","volume":"9","author":"Filippatos","year":"2026","journal-title":"Rep (MDPI)"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-025-07237-9","article-title":"The incidence of cerebral edema in pediatric patients with diabetic ketoacidosis: a retrospective study","volume":"18","author":"Memarian","year":"2025","journal-title":"BMC Res Notes"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1097\/pcc.0b013e3182196c6d","article-title":"Risk factors for cerebral edema in diabetic ketoacidosis in a developing country: role of fluid refractory shock","volume":"13","author":"Tiwari","year":"2012","journal-title":"Pediatr Crit Care Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1921269\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:43:27Z","timestamp":1790574207000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1921269\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":48,"alternative-id":["10.3389\/fendo.2026.1921269"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1921269","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1921269"}}