Simultaneous Acute Cerebral and Pulmonary Edema Complicating Diabetic Ketoacidosis

To report on a child with diabetic ketoacidosis (DKA) who developed simultaneous acute cerebral edema (CE) and pulmonary edema (PE), required extracorporeal membrane oxygenation (ECMO), and yet survived without significant neurological or pulmonary handicap.

A 3-year-old girl with DKA as the first manifestation of insulin-dependent diabetes mellitus (IDDM) sustained coincident acute CE and PE 9 h into therapy. The former responded to mannitol, but the latter matured into adult respiratory distress syndrome (ARDS) resistant to conventional management and requiring ECMO.

CE, PE, and ARDS can complicate DKA. Survival without sequelae is possible with aggressive treatment.